Procedural Conclusions
Mr Zolts cardiac catheterization went well with no immediate complications and his results were different than expected. Originally all previous Diagnostic Testing, Cardiac Echocardiogram and Cardiac MRI, pointed to Constrictive Pericarditis. This Catheterization was a surgical follow up of possibly treating this, however, upon examination of Left and Right Heart pressures it was determined that he did not have Constrictive Pericarditis. This was evident for the following reasons… The PCW Pressure (26 mmHg) is not equal to RA Pressure (20 mmHg), there is elevation of all diastolic pressures in the cardiac chambers but they are not equal, there was also no classical "dip and plateau" of the LV and RV waveform, and the…show more content… The PA Systolic pressure (50 mmHg) could be consistent with Constrictive Pericarditis, but it is not due to the other reasons listed above. And lastly, there did appear to be a large dip in the X and Y descent of some RA pressure waveforms but it was not consistent and so is not indicative of the Constrictive pericarditis’ "M" or "W" waveform signs. His Systemic Vascular Resistance (2081.85 dynes/sec/cm^2) and Pulmonary Vascular Resistance (454.22 dynes/sec/cm^2) is high, yet he has a preserved ejection fraction. This means there is blood flow resistance but the hearts…show more content… This is indicated by the left ventriculography showing a normal EF of 55 - 60% with no wall motion abnormalities. The patients Coronary Angiogram also showed 60 - 70 percent Stenosis of the mid Marginal artery that comes off the Circumflex. With all this in mind it is likely that this patient has Heart failure with a preserved EF in conjunction with, or secondary to, Post Capillary Pulmonary Hypertension (PCW pressure is greater than 15 mmHg). The patient also has Atrial Fibrillation as was evident on the procedural EKG. Atrial Fibrillation also affected the hemodynamic tracings of this patient. Even Though Mr Zolt is not a candidate for a pericardiectomy, Dr Nguyen suggested to change his diuretic from Microzide to Bumex. This is to help with renal function and may be used to decrease HTN. Dr Nguyen also suggested that his cardiologist (Dr Gutierrez) give him long term anticoagulation for his Atrial Fibrillation, and suggested for Mr Zolt to follow up with Dr Gutierrez. This makes sense considering atrial fibrillation may cause clots in some individuals. Due to the results of his Cardiac
