ABSTRACT
The authors report a case of cardiomyopathy of the right ventricle revealed suddenly in a presentation of pulmonary embolism in relation to a large thrombus that developed in an enormous, extremely hypokinetic right ventricle. The scenario suggests dysplasia without rhythm disorder. This case allows a discussion on the multiple variants of arhythmogenic dysplasia of the right ventricle.
Subject(s)
Cardiomyopathy, Dilated/diagnosis , Pulmonary Embolism/diagnosis , Ventricular Dysfunction, Right/diagnosis , Adult , Cardiomyopathy, Dilated/complications , Coronary Thrombosis/complications , Coronary Thrombosis/diagnosis , Humans , Male , Pulmonary Embolism/complications , Ventricular Dysfunction, Right/complicationsABSTRACT
We report the case of a 42 years woman known to have a cardiac heart failure attributed to restrictive cardiomyopathy for want of any other plausible diagnosis. Evolution and repeted investigations finally permitted to rectify the diagnosis by revealing a constrictive pericarditis, remained occult 9 years during. The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. Diagnosis of constrictive pericarditis is based on associated signs sometimes too poor to go straight to thoracotomy. We discuss the mean to approach more precisely this uncommon pattern named occult constrictive pericarditis.
Subject(s)
Cardiomyopathy, Restrictive/diagnosis , Pericarditis, Constrictive/diagnosis , Adult , Cardiomyopathy, Restrictive/diagnostic imaging , Diagnosis, Differential , Diagnostic Errors , Echocardiography , Female , Humans , Magnetic Resonance Imaging , Pericarditis, Constrictive/diagnostic imagingABSTRACT
The pseudonormal mitral profile is difficult to distinguish from a normal profile with echocardiography. Ever since a study showing that the Valsalva manoeuvre could unmask the appearance of relaxation disorders of transmitral flow (E/A < 1) in subjects with cardiopathy, this method has been proposed for the analysis of diastolic function. Very few data exist on the effect of this method in healthy subjects. The aim of this study was to evaluate the changes in mitral flow with this manoeuvre in middle aged healthy subjects, in order to establish the validity of this method for identifying the pseudonormal mitral profile. In 30 subjects (aged 50 +/- 5 years) we analysed mitral flow at rest and after the Valsalva manoeuvre, pulmonary venous flow, annular tissular Doppler, propagation velocity in colour TM and the combined indices (ENp, E/Ea). An inversion of the E/A ratio was obtained in 95% of subjects with an E/A ratio >1 (n=21, E/A=1.25 +/- 0.14) while all the other Doppler indices were in favour of normal flow. In conclusion, the inversion of mitral flow is very common in healthy subjects following the Valsalva manoeuvre. This observation underlines the limit of this method for distinguishing between a normal mitral profile and a pseudonormal profile. The optimal evaluation of diastolic function must rely on the various Doppler indices currently available especially for the detection of a developing cardiomyopathy.
