Cardiovascular Case Histories A 32-year-old nurse who had rheumatic fever as a child noticed a persistent tachycardia and light-headedness. Upon examination, chest x-rays showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation. There was also mild pulmonary edema. Cardiac evaluation resulted in the following information: Cardiac output (CO) 3.4 L/min Blood pressure (BP) 100/58 mm Hg Left atrial pressure (LAP) 16 mm Hg (normal 8-

Cardiovascular Case Histories

A 32-year-old nurse who had rheumatic fever as a child noticed a persistent tachycardia and light-headedness. Upon examination, chest x-rays showed an enlarged left atrium and left ventricle. ECG analysis showed atrial fibrillation. There was also mild pulmonary edema. Cardiac evaluation resulted in the following information:

1. Based on the information provided, which A-V valve is incompetent, allowing the regurgitation? How did you determine this?

1. If the other A-V valve were incompetent instead of this one, would the CO (L ventricle), and BP be different? If so, how? Would you expect the LAP to be normal?

1. Pulmonary hypertension can develop with L sided heart disease. What is pulmonary hypertension in this context? Why does it cause elevated RVP?  

1. Other than atrial fibrillation, what are the causes of the tachycardia, light-headedness, and mild pulmonary congestion in this patient?

1. Does the cardiac output concern you? Why or why not?

1. Name a danger/risk associated with atrial fibrillation.

The patient was untreated and presented a few years later with severe symptoms, including shortness of breath, extreme fatigue, diffuse peripheral edema and ascites (fluid accumulation in the abdominal cavity). Cardiac echocardiogram results:

Heart Rate (HR)                                 100 bpm                    

End-systolic volume (ESV)               140 mL

End-diastolic volume (EDV)             170 mL

1. Are the above values of ESV and EDV normal, high or low?

1. Calculate the stroke volume (SV), ejection fraction (EF), and cardiac output (CO) (show calculations).

1. What do you suspect is causing the new symptoms of peripheral edema and ascites?

1. Define Frank-Starling Law. How does it apply in this case considering the above values of ESV and EDV.?