20 Pages

Clinical Viva

WCC 3.0 × 109/L (4-11) K 4.8 mmol/L (3.6-5.0)

Platelets 242 × 109/L (140-400) Urea 2.5 mmol/L (1.7-8.3) PCV 0.28 (0.38-0.56) Creat 42 umol/L (62-124)

ECHO report LA: dilated LV: hypertrophied RA: Normal size and function RV: Normal size and function Aortic valve: Thickened, possibility of a bicuspid valve cannot be excluded; no calcification Valve area: 0.8 cm2

Peak gradient: 75 mmHg Mitral valve: Minimal mitral regurgitation Tricuspid Valve/Pulmonary Valve: Normal Systolic pulmonary artery pressure: 35 mmHg

Summarise the case. A high-risk primiparous pregnant woman in her third gestation, admitted with signs of decompensation with a background of underlying aortic valvular heart disease. The problems are: • Congenital bicuspid aortic valve with severe aortic stenosis with a high

gradient between the LV and aorta • Signs of left ventricular hypertrophy with strain • Pulmonary hypertension • Poor social history and medical follow-up

Describe the ECG. Rate: 90 Rhythm: Regular sinus rhythm Axis: Left axis

Intervals: • PR-Normal  • QRS-Normal

Segments: • ST Elevation lead V1-3  • ST Depression leads I, V5-6

Additional: • Voltage criteria left ventricular hypertrophy

° R wave lead I + S wave lead III > 25 mm ° R wave V5 + S wave V1 > 45 mm ° T wave inversion V1-6

• Diffuse ST segment and T wave changes, indicating strain

What findings can be diagnosed with a Doppler ECHO in a patient with valvular heart disease?