Question

A 74-year-old woman presents to the emergency department late one evening complaining of increasing shortness of breath, dizziness, and the sensation of her "heart racing." Her history is notable for longstanding, but now well-controlled, systolic hypertension. A physical examination demonstrates a blood pressure of 120/70 mm Hg and an irregular pulse of approximately 120 bpm at rest. The patient weighs 130 pounds with a body mass index within normal range of 22. An echocardiogram done a year earlier to evaluate left ventricular hypertrophy was notable only for mild, global left ventricular dysfunction with a left ventricular ejection fraction of 40% and mild mitral regurgitation. A subsequent exercise echocardiogram showed no evidence of myocardial ischemia. A repeat echocardiogram performed in the office demonstrates an abnormal impulse in the left ventricle with decreased left atrial ejection fraction of 20% with global hypokinesis but normal left ventricular systolic and diastolic dimensions with normal pulmonary arterial systolic pressure. What is the diagnosis?

Answer 1

Left ventricular heart failure with pulmonary hypotension is the diagnosis of the patient as the patient has shown the symptoms of abnormal impulses in the left ventricle with decreased left arterial ejection and left ventricular hypertrophy with shortness of breath and dizziness.

left ventricular heart failure occurs when the heart does not pump enough blood to the body and causes the dizziness due to lack of oxygen in the brain. Then, the blood backs-up in the lungs that causes shortness of breath and low oxygen saturation in the blood.