History
The patient had a history of acute myocardial infarction with triple vessel disease and underwent coronary artery bypass surgery.
Comments
This patient had congestive heart failure with an ischemic cause.
Current Medications
The patient was taking aspirin 80 mg daily, candesartan 8 mg daily, furosemide 40 mg daily, metoprolol 50 mg twice daily, and simvastatin 20 mg daily.
Comments
This patient was on optimal medical therapy.
Current Symptoms
The patient exhibited mild shortness of breath on exertion.
Comments
This patient was in New York Health Association class II.
Physical Examination
Comments
The patient had a dilated left ventricle.
Laboratory Data
Electrocardiogram
Findings
Bifid P wave was shown on the electrocardiogram (Figure 22-1) and nearly disappeared after AV optimization (Figure 22-2)
Comments
The electrocardiogram showed an enlarged atrium and interatrial delay before atrioventricular optimization and improvement after atrioventricular optimization.
Echocardiogram
Findings
When atrioventricular delay was set up as 30 ms, a truncated mitral valve A wave, with QA of 50 ms, was seen. (Figure 22-3)
FIGURE 22-1
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