0:00

This is a four chamber View and cine

0:03

mode since it's a screen capture from

0:06

a 14% image.

0:08

And that's followed by a short axis capture from

0:11

a cine image. And the last picture is

0:14

a delayed enhancement.

0:15

So delayed enhancement.

0:17

short access

0:19

And a Fortuner cine image still capture

0:22

in a diastolic frame.

0:24

Short access and the delay enhancement. I'm gonna put

0:27

leave the delete a delayed enhancement image up while we showing show

0:30

the poll questions. Can we have the First full question, please?

0:34

Given the history and the history is an older patient

0:37

who presents with left ventricular hypertrophy and diastolic heart

0:40

failure. The correct diagnosis is one of

0:43

these following hypertrophic cardiomyopathy air VC dilated cardiomyopathy

0:46

cardiac amylidosis are families disease.

0:49

Can we have a vote on what the audience thinks

0:52

the correct answer explains?

0:54

Okay, excellent. The majority of the of the

0:57

audience thinks that the correct diagnosis cardiac amyloidosis which indeed it

1:00

is notice that this patient has Global sub endocardial enhancement

1:03

in the left ventricle. It also enhancement in

1:06

the right ventricle. And in this finding in conjunction

1:09

with the left ventricular hypertrophy and the right ventricular wall

1:12

thickening small periodontal effusion bilateral Pearl

1:15

effusions indicates, a diagnosis of

1:18

cardiac amylidosis, the global sub in the

1:21

Carol enhancement is a characteristic and classiful classical for condic

1:24

amylidosis. No other disease conditions in associated

1:27

with left ventricular hypertrophy causes

1:30

that type of global subject account enhancement other patterns

1:33

of late-gal enhancement can be found in cardiacomole dose

1:36

include diffuse enhancement throughout the left ventricular Justin in

1:39

ability to Now The myocardium because there's diffusion enhancement

1:42

throughout the heart and furthermore on the ti

1:45

Scout or find the images The myocardium. It

1:48

may suppressed before the blood pool because the gandolinium kinetics

1:51

are altered and there's more gardening in The myocardium than

1:54

the blood.

1:54

in some case of contact amyloidosis, but in this case, there's

1:57

Global subintercard enhancement, right ventricle enhancement small pericardial

2:01

effusion, circumferential lv1 thickening right

2:04

ventricular wall thickening big Atria small

2:07

narrow, tubular ventricles all features of a restrictive cardiomyopathy

2:10

classical findings for

2:13

For cardiac amoledoses plural effusions

2:17

restrictive cardiomyopathy the common cause of diastolic heart

2:20

failure and restricted cardiomyopathy in an

2:23

older patient is cardiac amyloidosis and indeed. This is

2:26

a case of cardiac amyloidosis. Can we have

2:29

the next question, please?

2:31

The most common clinical presentation cardiac amylose is

2:34

which one of the following there's five choices here.

2:38

Okay, good. Wonderful. All participants gave the

2:42

correct diagnosis which is restrictive cardiomyopathy. So

2:45

amyloid is an infiltrated heart muscle disease. It's stiffens a

2:48

ventricles and presents typically presents as a restrictive cardiomyopathy cystolic

2:51

functions preserved in the early stages of the disease and

2:54

typically presents with diastolic heart failure and restricted cardiomyopathy. In

2:57

fact a very common cause of diastolic heart

3:00

failure, if other causes such as hypertension are excluded

3:03

in all the patients diabetes excluded is cardiac amylidosis.

3:06

In fact, it's an under diagnose disease increasing it

3:09

more recognizing it more increasingly in

3:12

this age two common types are ATT our amyloid

3:15

and Al amyloid the two

3:18

cannot be distinguished 100% by Kanye

3:21

Mr. If an ATT if attr amyloid is

3:24

is considered likely on the base of clinical features a

3:27

powerful State bones and is likely to be diagnostic but

3:30

County MRI plays a very important role particularly when

3:33

Echo suggests the disease or it's not conclusive the

3:36

presence of global Southern.

3:38

Enhancement or diffuse enhancement is highly suggestive of County Common doses

3:41

in a patients with the patient left ventricular hypertrophy pretty

3:44

clear. If there's other morphological features

3:47

into atrial septal thickening is it can

3:50

also be a finding dilated Atria narrow tubular

3:53

ventricles periodontal effusions plural effusions all morphological

3:56

features of cardiacomolidosis.

3:59

Okay, so that's a case of cardiacomolidosis not uncommon to

4:02

see this in clinical practice in cardiacomorphically in an older patient with

4:05

left ventricular hypertrophy.