Sanjiv Shah Profile picture
7 Dec, 4 tweets, 2 min read
#HFpEF pearl of the day: For echo diagnosis of ⬆️LV filling pressures, remember the 11-13-15 rule. Septal E/e' > 11 in A-fib, > 13 with exercise, > 15 at rest (in sinus rhythm) = ⬆️LV filling pressure is likely. None of these are perfect, but good rule of thumb.
Here is an example of elevated septal E/e' (> 11) in AF:
Here is a nice review on the topic: sciencedirect.com/science/articl…
Here is an example of septal E/e' > 13 during exercise (diastolic stress test).

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More from @HFpEF

8 Dec
#HFpEF pearl of the day: Evaluation of motion of the interventricular septum can be helpful to determine etiology/pathophys in HFpEF pts. Case: 58 yo man w/SOB, ascites, 2+ LE edema. EF 50%. Initially referred to hepatology for poss. liver failure. What did liver biopsy show?
What was the histologic finding on liver biopsy?
Read 14 tweets
6 Dec
Case: 63-year-old woman with long-standing rheumatoid arthritis presents with dyspnea, LE edema, fatigue. Exam JVP 12 cm, 3/6 holosystolic murmur at LSB, 1+ LE edema. LVEF 60%. TR gradient 40 mmHg, RA pressure 15 mmHg. PASP 55 mmHg.
Mitral inflow: E velocity 62 cm/s, A 35 cm/s, E/A ratio 2.1. Image
Septal TDI: Septal e’ 5 cm/s Image
Read 19 tweets
2 Dec
#HFpEF pearl of the day: HFrEF is failure of the LV, HFpEF is failure of the LA. If you want to successfully manage HFpEF in your patients, you need to know at least as much about the LA as you know about the LV.
Read 6 tweets
28 Nov
#HFpEF pearl of the day: HFpEF patients can have cardiac and extracardiac causes of volume overload. Abnormal LV GLS, reduced TDI velocities, and/or ⬆️⬆️ECG QRST angle (R axis – T axis) are clues to a more cardiac predominant phenotype.
Read 7 tweets
27 Nov
Here’s another case: 49 yo woman w/obesity (BMI 46), HTN, OSA on CPAP, schizoaffective with new-onset HFpEF (leg swelling, dyspnea, ⬆️JVP, BNP 226 pg/ml, LVEF 65%). Low H2FPEF score = 4 (obesity, HTN meds, E/e’ = 10). What's the diagnosis? More info....
Hospitalized 6 months ago with psychotic break, treated with uptitration of anti-psychotics, now back to baseline mental status. 60-lb weight gain over past 6 mo. Also +lightheaded/dizzy. Here's the echo: Image
More info: normal thyroid function, normal hemoglobin, no eosinophilia. She was taking lamotragine, risperidone, and citalopram for her schizoaffective disorder. RHC: RA 13, PA 37/24, PCWP 24, CO 9.2 L/min.
Read 5 tweets

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