4Physical Examination A middle aged man, no sign of distress Vital signs: BP 120/74 mmHg, RR 16 /min, PR 80 /min (irregular rhythm), BT 36.7°CHead&neck : not pale conjunctiva, anicteric sclera, no jugular vein dilatation, no carotid thrill or bruit
5Heart : -heaving at Lt. parasternal border -PMI at 6th ICS, lateral to mid clavicular line, no thrill all of valve area-decreased 1st sound, normal 2nd sound, pansystolic murmur grade III at apex, radiate to Lt.axillaLungs : no chest skin lesion, normal chest contour, equal bronchoalveolar breath sound, no lung crepitation
6Abdomen : not distended, soft, not tender, impalpable liver and spleen, active bowel sound Extremities : palpable pulse 2+ all of upper and lower extremities, no pre-tibial pitting edema, no clubbing finger
16Echocardiography Report Normal aorta and PANormal aortic and pulmonic valveSevere MR, ERO 36 mm2 (grade IV by PISA) with prolapsed PMLModerate TR ( RVSP 62 mm. Hg)Dilated LA, no LA thrombusImpaired LV systolic function, LVEF 40%LV eccentric hypertrophy and hypokinesia of anterior & lateral wallNormal RA & RV
17ProblemWhat type of Carpentier’s functional classification of MR in this case?Differential etiological diagnosis ?What is further proper management?
18In Our Opinion Echo interpretation: Etiology diagnosis: Severe MR Type II with cardiomyopathyEtiology diagnosis:Ischemic cardiomyopathyPlan of management:CAG