Jane Doe Case Summary

Jane Doe has a history of Hypertension, TIA, CAD and was a previous smoker. She received a cardiac catheterization in May of 2017 to check the function of the heart. In June of 2017 she came in with a complaint of right leg pain when walking a block and takes roughly an hour for the pain to subside.

We started with bilateral segmental pressures and VPRs of the lower extremities. The left leg has triphasic waveforms all the way down the leg with an ABI of 1.05. The VPR shows the limb is receiving adequate blood volume. The right leg has monophasic waveforms down the leg with an ABI of .61. The VPRs in the high and low thigh were moderately abnormal with the calf and ankle having mildly abnormal blood volume to the limb. Since the pain occurs

Is her pain from a stenosis in her arteries or from neurospinal compression? The next step, if true claudication, is to determine the extent of the vascular disease by stressing the patient. If the pressure drops post exercise and returns to baseline within 7-12 minutes it’s a multiple level disease. If the pressure does not return to baseline within 15 minutes and drops below 60mmHg, the leg is considered ischemic. The final step would be to figure out what is blocking the artery. Could it be a Stenosis or a blood clot? Jane Doe was found to have true claudication of the right leg. The stress test shows that her leg becomes ischemic post exercise. On 2D the only narrowing of the arteries in the lower extremity is in the right common femoral artery. We came to the conclusion that the narrowing of the artery is from a blood clot that formed post cardiac cath. A collateral has formed to supply blood to the leg at rest. During exercise that collateral cannot compensate for the increase demand of blood causing the significant drop in blood pressure and sever pain to the

The left atrium was slightly enlarged measuring 4.2cm and the IVSD measuring at 1.5cm. In the short axis, planimetry was preformed but did not receive an accurate valve area. M-mode through the aortic valve showed only 1.1cm of separation of the right and non-coronary cusps during systole. While in apicals, I was able to obtain a max pressure gradient of 34mmHg, peak velocity of 3.1m/sec and an aortic valve area of 1.5. The right side was hard to visualize and I didn’t get a full tricuspid regurgitation envelope. However, the IVC in subcostals did collapse, estimating the right atrium pressures to be 3 mmHg. The mitral regurgitation seen best in apical 2 chamber is moderate with the jet extending half way down into the left atrium. Obtaining values through the aortic valve in the presence of mitral regurgitation can cause under estimation of the aortic stenosis. A mitral regurgitation jet is wider than the jet coming from the aortic stenosis because the mitral regurgitations jet continues through IVRT and