Published on 02/03/2015 by admin
Filed under Internal Medicine
Last modified 03/03/2015
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Case 11
A 36-year-old man with a history of hypertension presented to the ED with the sudden onset of left-sided weakness. He also described a 6-month history of exertional dyspnea and leg edema. He had stopped taking his antihypertensive medications several months ago. He admitted to consuming a “moderate” amount of alcohol on a daily basis.
The baseline ECG demonstrates sinus rhythm, increased QRS voltage consistent with left ventricular hypertrophy (LVH), and nonspecific ST-T abnormalities possibly related to LVH. There is also evidence of biatrial conduction abnormality.
Parasternal long-axis and short-axis images demonstrate left ventricular dilation, increased left ventricular wall thickness, and severe global left ventricular systolic dysfunction with an estimated left ventricular ejection fraction of 20% to 25%. These findings are consistent with ischemic or nonischemic cardiomyopathy.
He was referred for adenosine stress 99mTc-sestamibi SPECT MPI to evaluate for ischemic cardiomyopathy as the cause for the left ventricular systolic dysfunction.
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