I have a heart problem

55 y/o male presents to A&E with shortness of breath and some mild chest pain.

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You are currently practicing in Rwanda and a 55 y/o male presents to A&E with shortness of breath and some mild chest pain, described as sharp and worse with exertion. He states that he was told he had "a heart problem."  He has no fevers, no cough, no history of HIV or intravenous drug use.

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Quiz

1) What echo view (PSL, PSS, A4C, SX) is being displayed in the images?

Apical four chamber

2) What are the labels on image 1 referring to?

A = RV B = LV C = LA D = RA E = Calcified mitral valve

3) What pathology is the color Doppler displaying in image 2?

Mitral Regurgitation, resulting in a very dilated Left Atria

4) Given the history and echo images provided, what type of cardiac disease do you think is causing the patient’s symptoms?

This patient likely suffered from rheumatic heart disease, which has led to a severely diseased mitral valve. The mitral valve is calcified and stenotic. The valve demonstrates characteristic bowing in, like a balloon, due to the severe stenosis. There is also mitral regurgitation during systole. The stenotic valve has led to elevated pressures in the left atria, causing severe left atrial dilation.