35 year old male, PMH including HTN, DM, OSA and obesity who presents to the ED with leg edema. Patient has noted some SOB and  for about a month and leg edema

  • tachy at 106,
  • BNP elevated to 398 but
  • trop negative.
  • CXR with some congestion in the hila.
  • Congestive Cardiomyopathy
    CXR with mild CHF and global cardiomegaly
    Ashley Davidoff
    thecommonvein.net

  • Pt was given 20mg IV Lasix
  • active smoker.
  • formerly a heavy drinker
  • CXR: 1. Moderate cardiomegaly with congested hila.
  • TTE: EF 25% with severe global hypokinesis and grade 3 diastolic dysfunction
  • Right heart cath
    • RHC
      • elevated filling pressures with
        • wedge of 30 mmHg and
        • RA 10 mmHg
  • Coronary Cath
  • INDICATIONS:
    Congestive Heart Failure

    CORONARY CIRCULATION:
    Left Dominant
    Left Main: Normal
    LAD:
    Left Anterior Descending: Normal
    LCX:
    Left Circ: Normal
    RCA:
    RCA: Anomalous origin from proximal LAD, normal, non-dominant

  • Coronary CT today to evaluate course of anomalous RCA showed
    • anomalous right coronary artery with prepulmonic course,
    • severe globally depressed biventricular function, and
    • no significant coronary artery plaque or stenosis.
Congestive Cardiomyopathy
Anomalous origin of the RCA from the proximal LA – non dominant right CA
Ashley Davidoff
thecommonvein.net
Congestive Cardiomyopathy
Anomalous origin of the RCA from the proximal LA – non dominant right CA
Ashley Davidoff
thecommonvein.net
Congestive Cardiomyopathy
Anomalous origin of the RCA from the proximal LA – non dominant right CA
Ashley Davidoff
thecommonvein.net