Order Pericardial Constraint Assignment Help

Order Pericardial Constraint Assignment Help
Order 5905980
Order Pericardial Constraint Assignment Help
Questions 1 to 3
A 64-year-old male presents to your clinic with progressive
dyspnea on exertion, lower extremity edema, anorexia, and
ascites. He has a history of Fabry disease with cardiac and
renal involvement. He has a history of lymphoma with previous radiation therapy and received successful orthotopic heart
transplantation for end-stage chronic systolic heart failure and
cadaveric renal transplantation 8 months earlier. He reports
full medication compliance, including tacrolimus, prednisone,
and mycophenolate mofetil. His postoperative course has been
uncomplicated, and he has undergone serial right heart catheterizations, which have previously shown normal lling pressures, and endomyocardial biopsies have shown no signs of
rejection. His chest x-ray and ECG are unchanged. He is admitted to the hospital from your ofce given the concern for possible rejection. Repeat right heart catheterization is as follows:
Right atrium: 19 mm Hg
Order Pericardial Constraint Assignment Help
Right ventricle: 38/20 mm Hg
Pulmonary artery: 35/20 mm Hg
(mean 27 mm Hg)
Pulmonary capillary wedge pressure: 19 mm Hg
Cardiac output by Fick: 4 L/min
Cardiac index by Fick: 2.3 L/min/m2
Pathology from the endomyocardial biopsy is pending.
Transthoracic echocardiography performed later that day
reveals the ndings in Video 45.1.
1. Given the diagnosis based upon the video, which of the
following factors is associated with the worst prognosis
after treatment?
A. Male gender
B. Prior radiation therapy
C. Pericardial effusion
D. Immune suppression
E. Fabry disease
2. Using the constrictive pericarditis survival graph in
Figure 45.1, which of the following options most accurately matches the etiology with the correct survival rate?
A. A = miscellaneous; B = radiation; C = idiopathic;
D = surgical
B. A = idiopathic; B = radiation; C = surgical;
D = miscellaneous
C. A = surgical; B = miscellaneous; C = radiation;
D = idiopathic
D. A = idiopathic; B = miscellaneous; C = surgical;
D = radiation
E. A = idiopathic; B = surgical; C = miscellaneous;
D = radiation
3. Which of the following mitral in‘ow Doppler patterns is least
likely to be present in the patient described in Question 1?
A. E/A ratio >1.2
B. E-wave deceleration time 60 cm/s
D. Variable isovolumetric relaxation time
E. Fixed response to volume loading
Chapter 45
Pericardial Constraint
Kunal Bodiwala and Vincent L. Sorrell
A
B
C
D
0
0
0.2
0.4
p = 0.0075
0.6
0.8
1
5 10
Years after pericardiectomy
Survival
15
Figure 45.1 Modified from Bertog SC, Thambidorai SK, Parakh K,
et al. Constrictive pericarditis: etiology and cause-specific survival after
pericardiectomy. J Am Coll Cardiol 2004;43(8):1445–1452.
(c) 2015 Wolters Kluwer. All Rights Reserved.
374 Section X Pericardial Disease
4. Which of the following pulsed-wave (PW) Doppler
spectral patterns would be least likely seen in a patient
with chronic constrictive physiology?
A. Tricuspid valve inow (Fig. 45.2A)
B. Mitral valve inow (Fig. 45.2B)
C. LV outow tract (Fig. 45.2C)
D. Descending abdominal aorta (Fig. 45.2d)
E. Distal right common carotid artery (Fig. 45.2e)
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