21505579 Visualization

A 75 Age – year Age – old Age female Sex presented Clinical_event in the Emergency Nonbiological_location Department Nonbiological_location of Nonbiological_location Ilfov Nonbiological_location Clinical Nonbiological_location Hospital, Nonbiological_location Bucharest, Nonbiological_location Romania Nonbiological_location , with dyspnea Sign_symptom , orthopnea Sign_symptom , lower Biological_structure extremities Biological_structure swelling Sign_symptom , palpitations Sign_symptom .
She had a 3 Duration years Duration history of atrial Sign_symptom fibrillation Sign_symptom diagnosed by her family Subject doctor Subject and one Duration - year Duration history of cardiac Disease_disorder failure Disease_disorder NYHA Lab_value (New Lab_value York Lab_value Heart Lab_value Association) Lab_value class Lab_value Ⅱ.
Physical Diagnostic_procedure examination Diagnostic_procedure revealed an irregular Sign_symptom pulse Sign_symptom 80 Lab_value beats/min Lab_value , blood Diagnostic_procedure pressure Diagnostic_procedure of 100/60 Lab_value mmHg Lab_value , bi Sign_symptom – basal Sign_symptom crackles Sign_symptom on chest Biological_structure auscultation Diagnostic_procedure , lower Biological_structure extremities Biological_structure swelling Coreference .
Heart Diagnostic_procedure sounds Diagnostic_procedure examination Diagnostic_procedure revealed a IVth Lab_value degree Lab_value pansystolic Sign_symptom murmur Sign_symptom at the left Biological_structure border Biological_structure of Biological_structure the Biological_structure stern Biological_structure .
The jugular Biological_structure veins Biological_structure were dilated Sign_symptom .
The patient complained of pain Sign_symptom in the upper Biological_structure right Biological_structure abdominal Biological_structure region Biological_structure , enhanced Detailed_description by Detailed_description palpation Detailed_description .
The liver Diagnostic_procedure margin Diagnostic_procedure was tender Texture , round Shape , of 6 Distance cm Distance below Distance the Distance costal Distance rib Distance , with a smooth Texture liver Diagnostic_procedure surface Diagnostic_procedure .
The spleen could not be felt.
EKG Diagnostic_procedure : atrial Sign_symptom fibrillation Sign_symptom of 80/min Lab_value , right Sign_symptom bundle Sign_symptom branch Sign_symptom block Sign_symptom , infero Biological_structure - lateral Biological_structure ischemia Sign_symptom .
Transabdominal Biological_structure ultrasound Diagnostic_procedure showed a homogenous Detailed_description , enlarged Sign_symptom liver Sign_symptom .
The suprahepatic Biological_structure veins Biological_structure were dilated Sign_symptom , as well as the inferior Biological_structure vena Biological_structure cava Biological_structure ( 30 Lab_value mm Lab_value , without respiratory variations).
Transthoracic Diagnostic_procedure echocardiography Diagnostic_procedure revealed a dilated Sign_symptom right Biological_structure atrium Biological_structure of 74,2 Lab_value mm Lab_value (Figure 1), dilated Sign_symptom left Biological_structure atrium Biological_structure of 55,2 Lab_value mm Lab_value , dilated Sign_symptom left Biological_structure ventricle Biological_structure of 64/72,3 Lab_value mm Lab_value , dilated Sign_symptom right Biological_structure ventricle Biological_structure of 44,4 Lab_value mm Lab_value .
Atrial Disease_disorder septal Disease_disorder defect Disease_disorder ostium Detailed_description secundum Detailed_description type Detailed_description , of 6 Distance cm Distance (Figure 2), with left Sign_symptom – to Sign_symptom – right Sign_symptom shunt Sign_symptom .
Severe Severity tricuspid Disease_disorder insufficiency Disease_disorder with maximum gradient of 55,4 Lab_value mm Lab_value Hg Lab_value .
4th Lab_value degree Lab_value mitral Disease_disorder insufficiency Disease_disorder .
Severe Severity pulmonary Biological_structure hypertension Sign_symptom of 75 Lab_value mm Lab_value Hg Lab_value .
The ejection Diagnostic_procedure fraction Diagnostic_procedure of 29% Lab_value .
Atrial Sign_symptom fibrillation Sign_symptom .
Interventricular Biological_structure sept Biological_structure with paradoxical Sign_symptom motion Sign_symptom .
Flattening Sign_symptom of the interventricular Biological_structure septum Biological_structure (Figure 3).
The diagnosis was IVth Lab_value degree Lab_value chronic Disease_disorder heart Disease_disorder failure Disease_disorder NYHA.
Atrial Other_event septal Other_event defect Other_event ostium Other_event secundum Other_event type Other_event with Other_event left Other_event – to Other_event – right Other_event shunt. Other_event
Severe Other_event tricuspid Other_event insufficiency. Other_event
4th Other_event degree Other_event mitral Other_event insufficiency. Other_event
Severe Other_event pulmonary Other_event hypertension Other_event of Other_event 75 Other_event mm Other_event Hg. Other_event
Chronic Other_event atrial Other_event fibrillation. Other_event
Right Other_event bundle Other_event branch Other_event block Other_event .