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72 year-old man has come to my office referred from GP to cycling test because of dyspnea. Dyspnea was very mild. He was and still is very active man that used to cycle 60 km every other day and he runs and hike a lot… and so on and so forth. Looks younger than he really is. He insisted that he is sick and wanted to be sent to angiography “in order to clean arteries” He has no symptoms to angina, heart failure, has no murmur over heart and not any legs swelling neither now nor in the past. No hypertension, diabetes. He is non-smoker and never smoked. I took cycling test (beneath) and he kan 9,2 Mets that is 175 Wat and his pulse came up to 149/min. I have stopped test but he said that could go much more and was surprised that I stopped. I took from my own initiative eccocardiography. That was not ordered.
What should I do with this patient? Is he healthy. Nothing more to do ?

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Pawel Hertz писал(а): ↑

Ср авг 15, 2018 11:34 pm

xyz

Mild diastolic dysfunction I degree in respect with mitral inlow,
Is this longitudinal strain reliable?
TR++, Gr- < 35 mm Hg

Its seem to me- you should do nothing. His heart looks good and 175w ? dont find black cat in dark room (when it absent in here)/
is there any suprise

I decidet to trust him and said to myself: "lets take a lab. tests first, if ok. I quit" I took troponin, ProBNP, D-Dimer 18.07.2018 and had agreement with him that on the day after I will ring him up... Should I do something after results

Wojtek Guzowski писал(а): ↑

Чт авг 16, 2018 12:16 am

Pawel Hertz писал(а): ↑

Ср авг 15, 2018 11:34 pm

xyz

Mild diastolic dysfunction I degree in respect with mitral inlow,
Is this longitudinal strain reliable?
TR++, Gr- < 35 mm Hg

I had assessed that diastolic function was ok, but this TR gradient in such a god trained man ??

Gradient of tricuspid /systolic peak is under 35 mm Hg, the risk is moderate,rather

After lab. results I called him on and next step was ulstrasound of the legs veins.

In my belief it is not only in right femoral but also thrombus in right tibialis posterior vein too

Do you monitor SpO2 during stress test?