about 50y old patient with known DCM for 5 years. Condition after CRT-D-implantation (indication: left-brandle block with QRS of 130-140 msec, LV-EF about 30-35%). Actually the patient was admitted to our ER with clinical symptoms of cardial decompensation and a NEW right-brandle-block with QRS of 200 msec!!! So we suggest a failure of CRT-D-system.
In TTE we found a distinct LV-function (measured by Simpson about 20%), a high grade mitral insufficiency and a small AI and PI (probably underestimated in context of severe deceased LV-EF).
Approach to CO: about 3,0 l/min (Sorry not shown, because I couldn´t convert my pictures in avi-format: LVOT-diameter 2,0 cm, LVOT-VTI 14,1 cm, heart-rate 65/min)
Approach to LVEDP: E-velocity: 0,58 m/sec, E`-velocity: 0,03 m/sec; Vp 19 cm/s; E/E`19,3 as an approach of LVEDP).
pulmonal hypertension (postcapillar): PAPs about 40 mmHg, RAP 5-10 mmHg estimated by IVC-collapsity, PV-ATC 70 msec, PV-VTI 7 cm, PAPd about 23-25 mmHg estimated by pulmonary insufficiency).