Question

80 year old woman presents with LE edema over last 2 months. Mobility impaired due to knee osteoarthritis but has become more tired and SOB with daily activities. Stomach feels full and appetite decreased. BP 136/77 and pulse is 70 and regular. JVD present in seated position. No murmurs. breath sounds decreased at bases. Abdomen is distended with flank dullness and percussion. 3+ pitting edema. HgB low, sodium low, Cr borderline low. urine albumin 1g/24hr. Echo shows left atrial enlargement, marked concentric ventricular hypertrophy and LV EF of 70%. Cause?

-restrictive cardiomyopathy

- congestive HF, echo shows concentric LVH and non dilated cavity with absence of hx of HTN. less common but important cause of HF with preserved ejection fraction.
-other manifestations: proteinuria (nephrotic sx); waxy skin (anemia), easy bruising, GI bleed, early satiety, subQ nodules; enlarged tongue, neuropathy

Answer 1

The 80-year-old woman's symptoms and echocardiogram indicate heart failure with preserved ejection fraction (HFpEF), likely due to restrictive cardiomyopathy, as evidenced by systemic congestion and left ventricular hypertrophy.

Step-by-step explanation:

The case described involves an 80-year-old woman experiencing lower extremity (LE) edema, shortness of breath (SOB), fatigue, and other signs and symptoms consistent with heart failure. The presence of Jugular Vein Distention (JVD), lower extremity edema, and abdominal distension, along with her echocardiogram findings of left atrial enlargement and very thick left ventricle walls (marked concentric ventricular hypertrophy), suggests she has heart failure with preserved ejection fraction (HFpEF). This type of heart failure occurs when the left ventricle of the heart is unable to relax properly, leading to increased pressures that back up into the lungs, causing pulmonary edema, and into the systemic circulation, causing systemic congestion evidenced by JVD and peripheral edema. This patient's clinical presentation is also suggestive of underlying conditions such as amyloidosis, which can lead to a restrictive cardiomyopathy—a less common but important cause of HFpEF—especially when considering additional manifestations such as proteinuria, waxy skin (anemia), easy bruising, and potentially enlarged tongue, and neuropathy.