🚩#Quiz Of The Week
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👈 #پاسخ :
🔸#Answer :

✅ Correct answer is C.
Bedside ultrasound revealed oligohydramnios and a single living foetus in a breech presentation. Foetal tracing showed reassuring pattern. Corticosteroid was given to promote foetal lung maturation, and elective Caesarian section was scheduled. Sildenafil was started on the night when she arrived, with careful monitoring of vital signs and clinical symptoms.
Right heart catheterisation was performed a day later, demonstrating severe pre-capillary pulmonary hypertension (mPAP 88 mmHg, PAWP 10 mmHg, PVR 17 WU) without oxygen step-up pattern.
CT scan revealed PDA (see below) Sildenafil was titrated up to 40 mg orally three times per day, without adverse event. Patient discharged after 10 days of admission, without hemoptysis or dyspnea.

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📚📖#آموزشی : 📚📖

🚩#Quiz Of The Week

* #ESCardioEd challenge by Marco Spartera and team, University of Oxford, England.

✳️ A 58-year-old female with worsening effort dyspnoea and fatigue. Clinical examination was notable for jugular venous distension and pitting oedema of the feet and ankles.
Past medical history: Persistent AF 2 years previously and heart failure symptoms, two catheter ablation procedures for AF, including pulmonary vein isolation and roof and mitral isthmus lines. However, symptoms of effort dyspnoea and fatigue had progressed despite maintenance of sinus rhythm.
Family history: dilated cardiomyopathy in the patient’s mother, but further details were not available.
Therapy : Warfarin, Bisoprolol 10 mg od, Ramipril 5 mg od, Spironolactone 37.5 mg od, Furosemide 20 mg od.
ECG: sinus rhythm with no evidence of ischaemia.
TTE: mild left ventricular (LV) dilation, with preserved LV systolic function and normal wall thickness, grade II diastolic dysfunction, mild right ventricle dilatation with preserved systolic function, sPAP 60mmHg. Both atria were moderate-severely dilated.
NT-proBNP: 1967 pg/mL. A 28 gene panel for DCM was negative.
At this stage, despite extensive investigations, no definite aetiology of heart failure was found. CMR is below.👇
The patient’s clinical condition slowly worsened with orthopnoea and NYHA class III heart failure requiring a brief hospital admission for intravenous diuretics. This culminated in a cardiac arrest whilst the patient was driving to attend an outpatient appointment, resulting in a serious motor vehicle accident on the motorway. Brought in hospital by ambulance, patient fully recovered neurologically. Repeat echocardiography revealed a dilated right ventricle with severe pulmonary hypertension. A further cardiac magnetic resonance scan is showed below. No change in the pattern of LGE was observed.

🔻What investigation is most appropriate?

A. Coronary angiography
B. Ventilation-perfusion scintigraphy
C. Right Heart catheterization
D. 7-day Holter ECG
E. Endomyocardial biopsy


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