Trial Short Case 1 September 2020

Case Summary

82-year-old man admitted under cardiology

Presented to ED with progressive shortness of breath

Known to have chronic mitral regurgitation

Background

MR under surveillance with cardiology

COPD – exsmoker

Hypertension

Independent with ADLs.  Still drives.

Walks 4-5km daily until two weeks ago

Medications

Aspirin 100mg

Atenolol 25mg

Ramipril 2.5mg

Atorvastatin 40mg

Spiriva

Examination

59kg, 168cm

HR 90 regular

BP 135/60

JVP not elevated

Nil peripheral oedema

Difficult to heart sounds. Soft pansystolic murmur loudest in the axilla.

Chest – diffuse wheeze

Investigations

Echo:

MR vena contracta 0.8cm diameter

LVEF 45%

Mild LV dilatation

RVSP 35mmHg

Normal RV function

Coronary angiogram: nil significant, right dominant.

Lung function: FEV 1.67L (62%), DLCO 34% predicted

Bloods: unremarkable

Trial Short Case 1 September 2020_CXR.png
 
 

Questions:

  1. Describe the aetiology and severity of this patients’ valve lesion and relevant indications for intervention

  2. In addition to further medical optimisation, what are the intervention strategies available for this patient?

  3. He and his family want to know the risks and benefits of each intervention strategy. Outline them.