Clinical history:
A young female, 22 years old, with a previous history of hypertension on various medications, the last one was amlodipine; she came to the clinic with complaints that her blood pressure was no longer controlled.
Please share with us in the comments what do you think about the diagnosis of this young lady? and what you be your next step? and what about her medications?
She denied any other symptoms and had no previous cardiac history, and she has no cardiac history in her family; on asked about the hypertension history, she reported that she had a previous normal echocardiogram and did most of the investigation for secondary hypertension, and all was normal.
The ECHO:
Apical 4 views:
Parasternal long view:
Short access view:
Suprasternal view:
Subcostal view:
Doppler across the mitral:
Doppler across the aorta:
What do you think?
Please share with us in the comments what do you think about the diagnosis of this young lady? and what you be your next step? and what about her medications?
Concentric LVH , good LV function
Parachute mitral valve , increased diastolic gradients across it ,
CoA , with significant gradient
TEE to exclude associated anomalies eg BAV , subaortic membrane ( we need aortic valve CW doppler image )
or supramitral ring
CT aorta to assess the whole aorta
MV repair and surgical coA repair vs Stent according to anatomy in ctA
BB is essential for HTN +/- other drugs
Thanks for your contribution. This is the first complete right answer!
You won 🙂
Aortic coarctation ,, doppler flow showed increased gradient with diastolic tail ..
next investigation would be CT aortogram or even MRI to decide proper management plan either angioplasty vs surgical repair
Regarding HTN ,, I think BB would be beneficial to be added
Thanks Dr. Salma for your contribution
This is a co-arch + parachute mitral valve, a part of Shone’s Complex
Nice good,
Emphasizing that good cardiologist must be a good echocardiographer.
You are the best
Suspected…parachut mitral with significant gradient over it suspected supra valvular membrane??? ,coarchitation with significant grading over descending aorta…
When both are be in Yong patient…shone complex is suspected..
Next step….TEE,CMR for exclusion also bicuspid valve..
Ttt….surgry
والله اعلى واعلم..
Thanks Dr. Ahmed for your contribution
This is a co-arch + parachute mitral valve, a part of Shone’s Complex
Aortic coarctation .. aortic Doppler shows increased gradient with diastolic tail ..
Next investigation would be CT aortogram or even MRI to help in deciding management plan either angioplasty or even surgical repair ..
Regarding HTN .. I think BB would be beneficial to be added
Thanks Dr. Salma for your contribution
Parachut mitral valve with significant gradient suspected supra valvular membrane…
Significant gradient over descending aorta suspected co-arc..
When both suspected in young patient….shone complex is suspected..
Next step…TEE,CMR….excluding bicuspid aorta ..
TTT…..surgry
Super!
Parachut mitral valve with significant gradient over it suspected supra valvular membrane..
Significant gradient over descending aorta suspected co-arc ..
Both in Yong patient… suspected shone complex
Next step…TEE,CMR
TTT….surgry
Mostly Shone’s complex
For TEE then CT aortogram if needed
Super!
Mostly Shone’s complex
For TEE and CT aortogram if needed
Super!
Coartication of Aorta, associated with mitral stenosis.next step: measure BP in lower limbs. Medication change depends on lower limb BP, can consider beta blockers.
Thanks Dr. Mohamed for your contribution
This is a co-arch + parachute mitral valve causing severe mitral stensis, a part of Shone’s Complex
CCTGA with LVOT obstruction
Thanks Dr. Ahmed for your contribution
This is a co-arch + parachute mitral valve, a part of Shone’s Complex
Shone complex
Super!