0:00

It's going to case number seven case number

0:03

seven is going to show some still images.

0:06

I'm going to show some movies where it's probably good

0:09

to look at the movies, right?

0:12

Okay case number seven the history here

0:15

is

0:17

is a young woman who presents with?

0:21

mono ocular blindness, I believe and

0:24

and heart failure. So heart failure is

0:27

a presentation a young woman who also has Oculus symptoms.

0:30

This is a short axis view right ventricle left

0:33

ventricle.

0:34

I'm going to go show a long axis of your cine images

0:37

show access then cine images in.

0:40

Sorry, this is the delay enhancement that while it's there.

0:44

Let's try to save there's any delay enhancement notice the bright areas in multiple

0:47

multiple spots. Let's look at the fortune of

0:50

you for chambercini image. That's a 4 chain

0:53

basini image.

0:55

And this young woman has heart failure.

0:58

Now I'm going to put a still image of the delay enhancement and we'll keep

1:01

this image on the screen while we answer

1:04

the question young woman with heart failure.

1:06

Delayed enhancement which image shown

1:09

what is the correct answer multi-vessel coronary

1:13

artery disease cardiac sarcoidosis erythogenic

1:16

RV cardiomyopathy, idiopathic delicious cardiomyopathy or

1:19

hypertrophic cardiomyopathy.

1:21

If you can say unfortunately, neither of these of these

1:24

are correct the correct diagnosis. He has cardiac sarcoidosis. This

1:27

is a young woman who has

1:30

dilated ventricles.

1:32

Notes, I'm going to go back to the image findings noticeable the

1:35

left and right ventricle. Sorry predomplay they

1:38

left ventricle was dilated. It's moving poorly the

1:41

ejection fractions under 35% and a key

1:44

feature in this case was the pattern of delayed enhancement

1:47

notice. There's multiple bright spots in

1:50

the heart.

1:51

Involving the sub endocardium, but also not involving the

1:54

serbiancardium in some areas. For example here the not in

1:57

a single coronary artery distribution, then multiple territories very unusual

2:00

for a patient to get infarctions in multiple territories.

2:03

And in areas which involve as well as do not

2:06

involve the sub-indocardium.

2:08

Furthermore. It's a younger patient ischemic heart

2:11

disease unlike any younger patient though it can occur.

2:14

The patient also has heart failure. So there's Global dysfunction

2:17

some of disproportionate to

2:20

the delay enhancement is also optic

2:23

optic symptoms judge in this particular case due to

2:26

opting neuropathy. So patient with cardiacodosis the key

2:29

finding here is multiple areas of enhancement in non-ish

2:32

gaming distribution in a younger patient

2:35

non-ish gaming cardiomack, they consider

2:38

cardiac sacredosis, which is under diagnosed in clinical practice or

2:41

out in the clinical World particular and

2:44

Mr. Is not shares the patient with cardiacredosis multiple

2:47

patch areas of enhancement.

2:49

And the patient who

2:52

presented with heart failure and also has Oculus symptoms. Okay cardiacortes

2:55

any questions as

2:59

the there was some confusion now particularly with

3:02

regard to the answers in this case, and it doesn't do not

3:05

seem to be any credit any answers any any questions so far,

3:08

so we'll go on to two more questions, but heading to this case

3:11

Question number two asks, which are the

3:14

following statement best characterizes cardiac sacredosis other

3:17

majority of the patient's a symptomatic or asymptomatic is

3:20

histological confirmation needed before treatment connection disturbances,

3:23

maybe evident.

3:25

consequent contraindicator of the pythonomic findings

3:28

and agriculture so which is one of the best characterizes so

3:31

there there's one statement here, which is

3:34

correct. And the other statements can be considered incorrect or not.

3:37

Not good choices. Okay. Can

3:40

we take a poll of what audience thinks following best

3:44

characterizes? Okay. Actually the correct answer here is

3:47

C connection disturbances, maybe evident

3:50

cardiac sarcoidosis typically presents with arithmias in

3:53

conduction disturbances because it involves a basin septum heart

3:56

block.

3:58

Is a typical feature of cardiac syncretosis

4:01

the others are wrong the majority

4:04

of patients cardigosa asymptomatic.

4:07

Histological confirmation is not needed before treatment because biopsy

4:10

of the heart is very difficult. They're frauded

4:13

complications and maybe falsely negative. So in histological

4:16

confirmation, the heart is not needed before treatment started typical treatment

4:19

is with conical steroids or with immunomodulators.

4:22

They are not any pathogenic findings on Echo car

4:25

geography While most abnormalities while thinning a wall

4:28

thickening maybe seen But Echo is not is not

4:31

Diagnostic in many case of cardiac sacredosis. And

4:34

Connie Kamar is generally needed to

4:37

evaluate for inflammation fibrosis. So

4:40

cardiac sarcoidosis multi multiple areas of

4:43

enhancement patchy enhancement typically involving the intervention.

4:47

May present with typical presentations are arithmiers.

4:51

conduction of normalities May proceed to have

4:54

heart failure and sudden death

4:56

typical treatments of Conquest steroids are immunomodulators particularly

4:59

if there's active information, okay last question

5:02

the commentary of scarring in cardiac sarcoders, which are

5:05

the following segments basal interventric reception inferior left

5:08

ventricle lateral left ventricle.

5:11

and tree left ventrico or anterior right

5:14

ventricle

5:15

Typically, which areas affected by late Gallery

5:18

enhancement oscarring and cardiacom and cardiac

5:21

sarcoidosis is a question.

5:23

Yeah basement of a nuclear symptom excellent a good choice the Communist

5:26

area affected by by scarring or

5:29

information contacts the basal interventricular septum as

5:32

as demonstrated by his logical examination

5:35

of Hearts. The other areas can be affected with

5:38

the common areas the basal interventricular septum.

5:41

So there's enhancement in Apache pattern the basil interventricular

5:44

septum consider soccer doses.

5:48

Codexancois has any questions on cardiac sarcoidosis lagenox

5:51

any further questions and contactos. So I think

5:54

we have time for

5:56

for at least one more case. It's 10:53. I think

6:00

we can proceed to case number eight.