Cath Measurement of Stenotic Aortic Valve Area心脏凯斯测量狭窄的主动脉瓣区（PPT53）课件.ppt

Cardiac Cath Measurement of Stenotic Aortic Valve Area Ryan Tsuda, MD Case Report: CC: Shortness of Breath HPI: 62 y/o Caucasian male, without previous significant medical history, presents with 6-8 months of progressively worsening dyspnea. Recalls 1 month h/o new onset leg and belly swelling. Describes 2 pillow orthopnea and occasional PND. Denies CP, syncope, or lightheadedness. Case Report: PMHx: Childhood murmur Meds: None All: NKDA SHx: Denies etoh, smoking, or illicit drugs FMHx: Did not have a relationship with his family, and therefore, is was not familiar with their medical problems. Case Report: PE: 97.6 115 159/109 26 100%2L Gen: Middle aged male with mild respiratory distress Neck: Short and thick, No obvious jvd CV: Tachycardic w/ RR, nl S1 S2, +S3, 2/6 crescendo decrescendo systolic murmur at URSB Pulm: Mild bilateral base crackles Abd: Diffuse abdominal wall edema, +shifting dullness GU: +scrotal edema Ext: 3+ Bilateral pitting edema Case Report: Na 143, K 4.3, Cl 105, CO2 30, BUN 23, Cr 1.3, Glu 108……… WBC 10.6 w/ NL diff, Hg 15.8, Hct 50.8, Platelets 219,000 ……. Tprot 6.7, Alb 3.5, Ast 66, Alt 57, Alkphos 127, Tbili 1.2 UA: +protein BNP 3690 Case Report: EKG: STach 115, LVH CXR: CM, Increased PVC, Small bil pleural effusions Initial A/P: New CHF…..Started on Natrecor, Lasix, Digoxin, Captopril, and Aldactone……More to follow……………………… Cardiac Cath Measurement of Stenotic Aortic Valve Area As valvular stenosis develops, the valve orifice produces more resistance to blood flow, resulting in a pressure gradient (pressure drop) across the valve Gorlin Formula Calculates cardiac valvular orifice area from flow and pressure-gradient data Incorporates 3 preexisting formulas