Medical Journal 12/19/18

Cough may be improving a little bit; using a phenolspray before bedtime seems to help.

Below are the results from the echocardiogram. EF is actually 35% rather than 40%,where anything over 55% is normal.

Several other findings sound sorta scary:

-severe mitral annular calcification

-small pericardial perfusion

-paradoxical septal motion

but I have no clear idea what they mean.

Study Result

Impression

CONCLUSION:

–There is no left atrial dilatation (LA volume index 28 ml/m²).

–The interventricular septum is mildly hypertrophied.

–The left ventricle has normal end-diastolic diameter.

–There is paradoxical septal motion. The basal and mid anterior septum, entire septum, and entire inferior wall are hypokinetic. Contractility of all remaining LV segments is normal.

–LV ejection fraction is moderately decreased (35 %).–There is no right atrial dilatation. The right ventricle is normal in size. The right ventricle has normal wall motion.

–There is aortic valve thickening. There is mild aortic stenosis. The aortic valve area, by the continuity equation, is 1.53 cm². The aortic valve area index is 0.7 cm²/m². There is mild aortic regurgitation. Aortic valve gradient is early peaking.

–There is severe mitral annular calcification. There is mitral valve thickening. There is moderate mitral regurgitation. There is MAC with a mitral valve gradient of 5mmHg at a heart rate of 77 bpm.

–The right atrial pressure is normal (0 -5 mm Hg). There is too little tricuspid regurgitation to estimate PA systolic pressure.

–There is a small pericardial effusion. There is a small pericardial effusion adjacent to the RA and RV without chamber collapse.

–No prior study available for comparison.

Narrative

NYU Langone Medical CenterAdult Echocardiography Laboratory560 First Avenue, New York, NY 10016Tel: 212-263-5664 Fax: 212-263-84612D Transthoracic Echo Report——————————————————————————–Pt. Name: MR. MARK A. KLEIMAN Study Date: 12/11/2018 Pt. ID: 13733272 Accession #: 16505925DOB: 5/18/1951 Ref. Physician: 1245564079 VASISHTA TATAPUDI Age/Gender: 67 M Sonographer: AM Height: 185 cm (73in) Fellow: Rebecca Pinnelas MD Weight: 111 kg (244 lb) BSA: 2.34 m²Location: Tisch NIC EPIC Code: ECH10-O—–

Indication: Preoperative cardiovascular exam

MEASUREMENTS:

Value Normal

Aortic 3.5 cm <4.4 cm LVOT 2.0 cm

Root Diameter LA 4.8 cm <3.8 (<4.0)

LVOT Area 3.1 cm² Diameter

LVOT Stroke 60 ml (25LA Vol 28 ml/m² <34 Volume ml/m²)

Index LVOTVmax 0.9 m/s— (rest) LVOTdPmax (rest)

IV Septum 1.3 cm <1.1 (<1.2)

LVOT V max

LVEDD 5.2 cm <5.3 (<6.0)

(Vals)Inf-Lat 1.1 cm <1.1 (<1.2)

LVOT dPmaxWall (Vals)LVESD 4.1 cm —-AV Vmax 1.9 m/s 1.0-1.7 LVED Vol 52 ml/m² <75

AV PeakIndex GradientLV Mass 107 g/m² <95 (<115)

AV MeanIndex Gradient——

AV Area 2-4 Impedance <3.5(Zva)

LVEF 35 % 50-70%

Aortic 453 msec——–Regurge P1/2——–

RAP, mean 3 mmHg 0-5PASP <35PADP <15 MV E wave 1.0 m/s 0.6-1.3RV-RA

VmaxPA-RV MV Mean 5 mmHgLA, mean <12 Gradient——-

MV Area 4-6——-

Mitral E 97 cm/sMitral A 144 cm/s TV E wave 0.3-0.7Mitral 0.7 VmaxE/A TV MeanDecel 188 msec GradientTi—-

Mitral P 55 msec1/2E’ 7 cm/s >8 RVOT(medial) DiameterE’ >8 RVOT Area (lateral) RVOT StrokeE/E’ 13.8 <8 VolumePV S/D RVOT Vmax

Normal values in parentheses are specific for men; normal aortic root values adjusted for age and BSA. LAVI data reflect 2015 ASE guidelines. PV Vmax 1.2 m/s 0.6-0.9PV PeakGradient—-BP 160/79mmHgHR 76 bpm

TECHNIQUE:Complete 2D transthoracic echocardiogram with color and spectral Doppler was performed. Study quality was good.

FINDINGS:

Left Heart:

–There is no left atrial dilatation (LA volume index 28 ml/m²).

–There is paradoxical septal motion. The basal and mid anterior septum, entire septum, and entire inferior wall are hypokinetic. Contractility of all remaining LV segments is normal. LV ejection fraction is moderately decreased (35 %).

Legend: 0=not seen; 1=normal; 2=hypokinetic; 3=akinetic; 4=dyskinetic;5=aneurysmal

Mitral Valve:

–There is mitral valve thickening. There is severe mitral annular calcification. There is moderate mitral regurgitation. There is MAC with a mitral valve gradient of 5mmHg at a heart rate of 77 bpm.

Aortic Valve:

–There is aortic valve thickening. There is mild aortic stenosis. The dimensionless index is 0.47. The aortic valve area, by the continuity equation, is 1.53 cm². The aortic valve area index is 0.7 cm²/m². There is mild aortic regurgitation. Aorticvalve gradient is early peaking.

Aorta:

–The aortic root is normal in size.Right Heart and Systemic Veins:

–There is no right atrial dilatation.

–The right ventricle is normal in size. The right ventricle has normal wall motion.

–The right atrial pressure is normal (0 -5 mm Hg). There is too little tricuspid regurgitation to estimate PA systolic pressure.

Tricuspid Valve:

–There is trace tricuspid regurgitation. Pulmonic Valve:

–There is trace pulmonic regurgitation.Pericardium and Effusions:

–There is a small pericardial effusion. There is a small pericardial effusion adjacent to the RA and RV without chamber collapse.–

CONCLUSION:

–There is no left atrial dilatation (LA volume index 28 ml/m²).

–The interventricular septum is mildly hypertrophied.

–The left ventricle has normal end-diastolic diameter.

–There is paradoxical septal motion. The basal and mid anterior septum, entire septum, and entire inferior wall are hypokinetic. Contractility of all remaining LV segments is normal.

–LV ejection fraction is moderately decreased (35 %).

–There is no right atrial dilatation. The right ventricle is normal in size. The right ventricle has normal wall motion.

–There is aortic valve thickening. There is mild aortic stenosis. The aortic valve area, by the continuity equation, is 1.53 cm². The aortic valve area index is 0.7 cm²/m². There is mild aortic regurgitation. Aortic valve gradient is early peaking.

–There is severe mitral annular calcification. There is mitral valve thickening. There is moderate mitral regurgitation. There is MAC with a mitral valve gradient of 5mmHg at a heart rate of 77 bpm.

–The right atrial pressure is normal (0 -5 mm Hg). There is too little tricuspid regurgitation to estimate PA systolic pressure.

–There is a small pericardial effusion. There is a small pericardial effusion adjacent to the RA and RV without chamber collapse.

–No prior study available for comparison.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com