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Case Sharing: A Case of Multidisciplinary Catheterization for Severe Aortic Stenosis with Cardiogenic Shock
Dr. Yu Hoshika, Nippon Medical School Hospital
Case Example
Female in her late 80's
Chief complaint
Dyspnea
Current medical history
She had been visiting her local doctor for hypertension, diabetes, and dyslipidemia. She started experiencing edema in her lower legs since the summer of 20xx with dyspnea on exertion since the end of September, and was unable to go outside. 4 days before admission in October, she visited the outpatient clinic of her previous doctor in a wheelchair for treatment of heart failure.
Bilateral pleural effusions, enlarged heart, and high BNP level (4,509pg/mL) were observed, and she was admitted to the ICU of her previous doctor, where she was treated with diuretic (furosemide 40mg/day), but she developed CO2 narcosis and trachea on the 4th day of illness. After intubation, hypotension was observed, echocardiography showed severe AS. The patient was transported to our CCU under the administration of catecholamine (DOA5 γ).
Life history
Living alone, ADL of guided-walking at home
Eldest son visits every few days, eldest daughter visits once a week
Medical history
High blood pressure
Dyslipidemia
Medications
Nifedipine CR 40mg 1T 1×,
Candesartan 4mg 1T 1×,
Bezafibrate 200mg 1T 1×,
Physical examination
- Height 146cm, Weight 48kg
- Consciousness level E2VTM6
-
Blood pressure 94/61mmHg (DOA 4γ, Nad 0.3γ), Heart rate 100/min.
- Oxygen saturation 100% ( FiO2 0.4)
- Chest Levine IV degree systolic ejection murmur at 2RSB
- Lower leg edema
Blood Tests.
Mild anemia, elevated CRP, and liver dysfunction were noted, with elevated TropT and N...
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