- 60-year-old woman
- Ischemic cardiopathy with NSTEMI (11/2024) and PCI of OM1. TTE: LVEF of 60% and moderate primary mitral regurgitation and aortic stenosis
- Diabetic nephropathy with end-stage CKD on chronic haemodialysis via left AVF, with preserved residual diuresis
- CVRF: essential hypertension, T2DM (insulin-dependet), hypercholesterolemia
- Home medication: Clopidogrel 75mg, Asprin 100mg, Atorvastatin 80mg , Nebivolol 5mg, Lecarnidipine 10mg, Doxazosin 4mg, Tamsulosin 0.4mg
- Sudden acute dyspnea and retrosternal chest pain (crushing, rest-related, <20 minutes, recurrent)
- Onset: one day after dialysis (-2.5 kg UF)
- Flu-like symptoms in the previous days
- BP: 190/80 mmHg, HR: 95 bpm, SpO₂: 80%, RR: 25 bpm
- GCS 15/15, normal neurologic exam
- Bilateral fine crackles at lung bases, no peripheral edema. Warm periphery
- ECG: Sinus rhythm, normal PQ interval, delayed R wave progression,slight notsignificant ST depression (V3–V6), no significant repolarization abnormalities (unchanged from Nov 2024)
- ABG: pH 7.43, pCO2 33 mmHg, PaO2 41 mmHg, HCO3- 21.9 mmol/L, Lactate 1.5 mmol/L, SaO2 78%
- Significant dynamic increase in hs-Troponin I (from 47 to 503 ng/L); BNP 937 pg/mL
- Na+ 122 mmol/l, K+ 4.6 mmol/L, creatinine 700 µmol/L, urea 20 mmol/L, ALT 10 UI/L, AST 17 UI/L. CRP: 7 mg/L. Glucose: 45.5 mmol/L, HbA1c: 11.7%. Hb 8.4 g/dL, WBC 10⁹/L
Patient Profile
Current Presentation
Clinical Findings
Electrocardiogram
Labs
Chest X-ray
Cardiomegaly, signs of volume over load with redistribution of pulmonary blood flow up to the apices, without pleural effusion.
Echocardiography
In general normal LV function with preserved segmental and global wall motion and stable valvulopathy.
Parasternal long-axis view showing left ventricular hypertrophy and aortic valve calcification.
Apical four-chamber view showing a non-dilated left ventricle with preserved ejection fraction, a right ventricle of normal size and function, mildly dilated left atrium, and small pericardial effusion anterior to the right atrium associated with partial diastolic collapse.
Mitral inflow Doppler profile. Pulsed-wave Doppler tracing of transmitral flow showing normal E and A wave velocities (E = 79.7 cm/s; A = 109.1 cm/s), with an E/A ratio <1 and prolonged deceleration time (DT) (316 ms), consistent with impaired relaxation pattern.
Continuous-wave Doppler of the aortic valve showing a mean pressure gradient of 23.4 mmHg, with a mean velocity of 2.4 m/s. These findings are consistent with at moderate aortic stenosis, assuming a normal stroke volume.
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(No subject)