Most people we see with acute decompensated heart failure with congestion are secondary to HFpEF ( 50% vs HFrEF)
Unfortunately, 90% of the echoes are read wrong in either direction .
I posted this clip to show some of the measurements that go into it . Even when the parameters are obtained a correct diagnosis is still a challenge .
A pearl here is that patients with a normal size LA by CT scan or ECHO rarely have acute decompensated CHF unless acute MR from flail leaflet for example ( myxomatous valve) , or ischemic MR as two examples . There are others off course .
If their LA is very large they probably do have elevated LA pressure and the diagnosis of ADHF with congestion.
For example grade III DD is impossible with a nomal size LA . I rarely believe DD with elevated LAP unless I can look at CT and ECHO myself or the clinical scenario is compatible with this diagnosis.
Unfortunately, 90% of the echoes are read wrong in either direction .
I posted this clip to show some of the measurements that go into it . Even when the parameters are obtained a correct diagnosis is still a challenge .
A pearl here is that patients with a normal size LA by CT scan or ECHO rarely have acute decompensated CHF unless acute MR from flail leaflet for example ( myxomatous valve) , or ischemic MR as two examples . There are others off course .
If their LA is very large they probably do have elevated LA pressure and the diagnosis of ADHF with congestion.
For example grade III DD is impossible with a nomal size LA . I rarely believe DD with elevated LAP unless I can look at CT and ECHO myself or the clinical scenario is compatible with this diagnosis.
You see from the slide show no busy cardiologist will look at this and the the tech has to set wall and gain filters just perfect .
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