0:00

All right. Let's go to the next case moving

0:03

right along here's case 9.

0:06

And let's blow this one up a bit and I'll start

0:09

from the top. I'll scroll through. So I want you to

0:12

look at everything. Now. I'm going to give you the fact that

0:15

this person has some coronary artery disease. So that's that's

0:18

a given here.

0:20

Let's scroll on down and look at the heart all

0:23

the chambers.

0:25

Everything that's going on.

0:31

I'll scroll back up.

0:37

Okay. So let's open the polling for this case and

0:40

see what people think. Where is the most significant abnormality?

0:45

And just ask yourself what you think this abnormality is?

0:51

And let's put up the poll question.

0:56

And I'll continue scrolling through this.

1:05

Blow up the hurt a little bit more.

1:07

Okay, so let's close the poll question.

1:11

And let's see what people thought.

1:16

All right. Where did you think the most significant abnormality was? Some people

1:19

thought cardiac Chambers some people thought septum and

1:22

I've left that broad so they could mean enter

1:25

atrial or interventricular septum and then

1:28

other people thought myocardium and it is true

1:31

that The myocardium

1:34

looks a little bit thick the LV looks a little bit thick

1:37

but let me show you the most significant abnormality here.

1:40

So what about this so along the

1:43

inter atrial septum you see a bulge

1:46

a big bulge here and it's bulging

1:49

from the left side to the right side and at

1:52

first glance she might think wow, you know,

1:55

I'm showing you another case of an ASD

1:58

and atrial septal defect. But in this case, it's important

2:01

now that there are other things that can look somewhere to

2:04

an interracial septal Defector and

2:08

atrial Supple defect and this is actually and interest

2:11

atrial septal aneurysm

2:14

So the supplement can actually thin and become

2:17

aneurysmal and the reason this is important to

2:20

recognize is first of all not to

2:23

mistake it for something else not to mistake it for

2:26

a huge ASD per se and not to

2:29

mistake it for a mass. And also the other thing that's

2:32

associated with these is you know, a PFO

2:35

paid in Freeman o'valley tends

2:38

to be highly associated with this particular

2:41

abnormality. So when you see

2:44

one of these you may want to just recommend getting an echo just

2:47

to check and see if patients have a pain

2:50

Freeman a valley that's associated with this. So this

2:53

isn't interracial septal aneurysm and the other

2:58

Interesting thing about these is that this is

3:01

the normal direction for them to be facing. They should be

3:04

bulging to the right side because of the higher pressure

3:08

on the left side, but these pressures

3:11

can be reversed in cases of elevated right-sided

3:14

pressures, like pulmonary emboli acute right

3:17

heart strain and just chronic homemade hypertension

3:21

and they can actually then flip over

3:24

and bulge from the right side to the left side and

3:27

I've seen that happen acutely. So that's something interesting

3:30

to look for.