How would you evaluate the patient’s left ventricular function?
Answer:
Medical history: history of MI and presence or absence of angina
Symptoms and clinical signs of left ventricular failure (dyspnea at rest or exercise, nocturnal orthopnea) and/or right heart failure (ascites, pitting edema, jugular vein distention)
Cardiac catheterization, angiography, and echocardiography
Ejection fraction (normally approximately 65%)
Left ventricular end-diastolic pressure (LVEDP) or PAOP: normal 6 to 15 mmHg
Left ventricular wall motion (by echocardiography)—normal (wall thickening of >30%), hypokinesis (wall thickening of 10% to 30%), akinesia (wall thickening of <10%), or dyskinesia (outward motion during systole) (Fig. 5.2)
Cardiac index (normal >2.2 L/min/m2)
Myocardial viability studies (contrast echocardiography or positron emission tomography study)
Segmental wall motion abnormality (SWMA) is the result of CAD. The interruption of perfusion results in abnormal motion in the related myocardial segments. There is a gradation of wall motion abnormality that consists progressively of hypokinesis, akinesis, and, subsequently, dyskinesis in which a wall moves away from the center of the ventricle. Wall thickening and endocardial motion are intrinsically tied, and all SWMAs are expected initially to be associated with abnormalities of thickening as well as endocardial motion.
Reference(s):
- Kaplan JA, Augoustides JGT, Manecke GR, et al, eds. Kaplan’s Cardiac Anesthesia for Cardiac and Noncardiac Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:179-205, 390-426.
- Schuleri KH, Centola M, George RT, et al. Characterization of peri-infarct zone heterogeneity by contrast-enhanced multidetector computed tomography: a comparison with magnetic resonance imaging. J Am Coll Cardiol. 2009;53(18):1699-1707.