DCM or isolated Atrial fibrillation?

RE: DCM or isolated Atrial fibrillation?

Anthony Dennison — Tue, 29 Oct 2019 17:32:27 GMT

Thanks for the replies. Don't have a good still image of the RPLA 4 chamber view but have a poor quality clip showing the left ventricular function. Just need to figure out the best way to get it on here for people to see!

RE: DCM or isolated Atrial fibrillation?

AlanH — Tue, 29 Oct 2019 17:24:17 GMT

Hi Anthony,

Interesting one, the weak pulses and poor CRT suggesting poor systolic function and I'd be thinking DCM too from this presentation.

ECG: tall qrs ( nearly 6mV so thinking LV enlargement) then abnormal run with no obv P waves and irregular r-r with variable r wave height - Im thinking paroxysmal AF ( is that a thing?!) though it does look like the occasional P wave visible through this - in which case a run of supraventricular premature beats - SVT I always thought tend to be regular though so that doesnt fit.

The M Mode images - I'm thinking the IVS measurements include a hypoechoic band which doesn't seem right and the LVFW I'm wondering if there is a papillary muscle getting in there too so not convinced bout the numbers on that one but doesnt shout out DCM to me either. Did the LV look spherical?, Ejection fraction and measuring volumes using SMOD would be interesting too

I'd be looking again at the scan - sounds like DCM to be with secondary arrhythmia, I'd be going with pimobendan and be interested to see what others are thinking on this one If your sure not DCM maybe consider troponin for myocarditis as a cause of arrhythmia which could be leading to a secondary systolic issue but appreciate not cheap!

Good luck with this one!

RE: DCM or isolated Atrial fibrillation?

Dave Dickson — Tue, 29 Oct 2019 16:49:19 GMT

Hi Anthony

Any chance you saved (and can post) and RPLA 4-chamber view? I don't trust the M-mode measurements, I think your free wall cursor has drifted into a papillary muscle so the LVIDs is artifactually small. A video would be much easier to appreciate I think.

Dave

RE: DCM or isolated Atrial fibrillation?

Anthony Dennison — Tue, 29 Oct 2019 16:43:28 GMT

Sorry, don't know why the ECG has turned upside down! We've just got an ECG attachment for our scanner today but need the atraumatic clips for them so haven't used it yet.

RE: DCM or isolated Atrial fibrillation?

Anthony Dennison — Tue, 29 Oct 2019 16:40:53 GMT