Case 13 Cardiology

Discordant Heart Failure

Work it one clue at a time. The diagnosis stays hidden until you reveal it.

Clue 1

A 60 y/o man w chronic systolic HF is admitted with increasing dyspnea on exertion, orthopnea, and fatigue. Says his weight hasn’t changed much recently. We perform a quantitative assessment of the jugular venous pulse. Video starts w patient at 60 degrees and then reclines.

Clue 2

The pulse is visible just above the clavicle at 60 degrees. We estimate RA pressure to be mildly elevated at ~12-14 cm H2O (9-10 mm Hg). Are you surprised? Do symptoms seem out of proportion to RA pressure? Next we perform a qualitative assessment. What do you notice?

Reveal next