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Case Reports
. 2021 Jun 22;143(25):2502-2507.
doi: 10.1161/CIRCULATIONAHA.121.053615. Epub 2021 Jun 21.

Things Are Not Always as They Seem: Multimodality Exercise Assessment in the Evaluation of Dyspnea

Vidhu Anand  1 , David Bradley  1 , Robert L Frye  1 , Barry A Borlaug  1
Affiliations
Case Reports

Things Are Not Always as They Seem: Multimodality Exercise Assessment in the Evaluation of Dyspnea

Vidhu Anand et al. Circulation. .
No abstract available

Keywords: bundle branch block; diagnosis; diastole; exercise; heart failure; ischemia.

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Figures

Figure 1:
Figure 1:. Invasive Hemodynamics.
Pulmonary artery wedge pressure (PAWP, red) at rest (A), during low-level exercise prior to the onset of left bundle branch block (LBBB) (B), and during the transition from normal conduction with narrow QRS (green) to LBBB (C). Note the dramatic increase in the amplitude of PAWP V waves beginning within 3 beats following the onset of LBBB.
Figure 2:
Figure 2:. Hemodynamic changes with onset and resolution of LBBB.
Pressure tracings at slower sweep speed and expanded ordinate showing arterial blood pressure (BP) (black), pulmonary artery wedge pressure (red), and ECG (green) at the initial onset of left bundle branch block (LBBB) (A) and during a transient resolution of LBBB following an increased cycle length due to premature ventricular contraction (B). Note the dramatic reduction in systemic BP with LBBB that instantly improves with normal conduction.
Figure 3:
Figure 3:. Assessment of myocardial ischemia and coronary anatomy.
Top panel shows the results of arterial and coronary sinus blood sampling. Bottom includes coronary angiogram revealing significant stenosis in mid left anterior descending artery lesion (left) and with significant luminal obstruction by intravascular ultrasound (right).
Figure 4:
Figure 4:. Exercise stress echocardiography.
Apical two chamber view with color Doppler showing mild mitral regurgitation at rest (A) increasing to severe mitral regurgitation with 20 Watts exercise (B). Panel C shows zoomed-in view of mitral valve with severe mitral regurgitation at 20 Watts exercise.
See this image and copyright information in PMC

References

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