16th Annual Scientific Meeting - Heart Failure Society of America

Sept. 11
Tuesday
AM
Tuesday
CASE DISCUSSION
Tuesday, September 11
10:30 AM-NOON
Ballroom 6B
Case Presenters: James C. Fang, Cleveland, OH
Gary S. Francis, Minneapolis, MN
10:30 Case 1: A 27 y/o healthy mother delivers a healthy infant
who quickly develops a severe, dilated cardiomyopathy and
undergoes successful heart transplantation at one month of
age. During this time the mom develops symptoms of early
heart failure and the echo indicates features of an early,
mild, dilated cardiomyopathy (LVEDd=58mm and the EF
=42% with global hypokinesis). The mother, an RN, asks
you whether she has post-partum cardiomyopathy, or if she
has familial dilated cardiomyopathy.
10:48 Case 2: An 18 y/o high school All-American basketball
player from Chicago comes to see you because he felt
lighted on the basketball court during a game. All the
findings are consistent with HCM, but there is no LVOT
obstruction at rest or during provocation or maximal
exercise. There are no risk factors for sudden death. A
MRI indicates minimal fibrosis of the heart. He has a full
scholarship to Kentucky, Michigan and Duke. His local
cardiologist, a well-known professor in Chicago, strongly
believes that the patient should have an ICD and be allowed
to play in college, and his parents also favor this pathway.
The patient wants your opinion.
11:06 Case 3: 75 year old man is admitted for 3rd time with
appropriate ICD shocks. Underwent previous CABG 5
yrs ago; all grafts patent. Underwent VT ablation last
admission; on amiodarone. RHC notable for RA 6, PCW
18, PA 45/20/25, CI 2.1. Echo EF 15%, EDD 7.0 cm.
BUN 35, Cr 1.5. Patient maintains he is NYHA II between
shocks. Primary cardiologist suggests LVAD after hearing
your recent CME talk about LVADs.
CASE DISCUSSION
11:42 Case 5: A 37 y/o woman blood type O with advanced
dilated cardiomyopathy (EF=22%, NYHA Class III) is
referred to you for management. There are two issues that
the referring physician wants you to clarify: The patient
has a dilated LV with an LVIDd of 64 mm, and severe
4+ MR with restricted mitral valve leaflet motion. The
PVR, TPG and PA pressure indicate she is an acceptable
transplant candidate. Can or should the MV be considered
for repair? The other problem is that she is not tolerating
her medications (carvedilol, lisinopril, spironolactone and
furosemide) very well due to symptomatic hypotension.
These are being down-titrated. How does one down-titrate?
He asks you “is it time for an LVAD, or even MV repair and
then an LVAD”? He is from the University of Michigan
where MV repair for severe MR and a low EF is frequently
performed.
Panelists:
Michele A. Hamilton, Los Angeles, CA
Soon Park, Rochester, MN
Patricia A. Uber, Baltimore, MD
Sarah C. Paul, Hickory, NC
Mario Talajic, Montreal, QC Canada
Learning Objective: Using practice guidelines, research
findings and clinical experience, make decisions about the
management of difficult cases in heart failure.
Sept. 11
Tuesday
AM
Tuesday
11:24 Case 4: 60 year old woman is referred for coronary
angiography for new onset heart failure. Has been NYHA
II-III for past month. Echo shows EF 25%, moderate MR,
EDD 6.5 cm. No angina. Initiated on lisinopril 5mg,
bisoprolol 2.5 mg, furosemide 40 mg. Cath shows 70% mid
LAD, 80% ramus, and 90% lesion in proximal dominant
RCA. RHC notable for RA 12, PCW 22, PA 50/25/30, CI
2.4. Interventionalist pages you to let you know he is ready
to stent RCA. Husband wants patient to see senior cardiac
surgeon he personally knows.
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