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We're going to review approximately 12

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cases today cardiacomark cases

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that we see in routine clinical practice. They are

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labeled 13 on words because this is a continuation of of a

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session that was started a couple of weeks ago first

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case here. We have

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a four chamber Sydney image here that's playing and it

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belongs to a young woman who has an erythria.

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But there's two videos here and they're going to be followed by a question.

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This is a fort chamber Sydney. It's bright blood

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gradient. Echo image.

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And the history is a young woman with an

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arrhmia. It's a four chamber cine image a

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great Echo steady state repossession the standard cine

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Imaging used for cardiac MRI a

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steady state free processions integrating Echo image, four chamber

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View, and now I'm going to go to a short

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axis View.

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And here is the shot axis view.

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This is the short axis View.

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And I'm going to minimize this and once again

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bring up the four chamber view. We'll let the fort chamber view play and

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we're going to answer the questions. Okay, so based

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on these two images. I'm going to I'm going to let this for chamber cine

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play this three questions. Can I request the

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first question to be put on please?

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So the correct diagnosis is one of these for a geographic dilated cardiomark

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the hypertrophic cardiomyopathy myocarditis arvd

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or sea which stands for earthmogenic right ventricular

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dysplasia and cardiac sarcoidosis. And

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can I request the participants to to vote on

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what they think is the best diagnosis 14 basini image

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in a young patient with arrhythmia.

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Okay, six or seven percent of the participants bull

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for idiopathic DCM and 33 for

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an arvc. We point out to the abnormality here

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notice that the right ventricle has an area of this kinetic

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wall motion notice that there's an aneurysm in

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the right ventricular free wall anterior free. Wall right there. This portion

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of the right to ventricle being pointed to is not moving properly. It's

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moving outwards. It's aneurysmal.

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That indicates that there's a abnormal right ventricle and it

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shows an area of aneurysm aneurysm of

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annotation and movement disconnected area furthermore

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on the short axis view, which I'm going to pull up

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in a minute here. You see a still picture here in the

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short axis view. The right ventricle is dilated. It's bigger than the left ventricle.

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Furthermore this is the systolic image of the four chamber

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view notice the akinetic region. So actually it's

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disconnected. It's moving outwards in Sicily. That's a

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diastolic frame. That's a systolic frame. You see it's moving outwards indicating

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that it's aneurysmal. The right ventricle is

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dilated. These are features which support the presence of arvc earthmogenic

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right ventricular cardiomyopathy and for

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a diagnosis of air we see a kinesia disk and

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easy of the right vertical is essential by 2010 task

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force criteria and you see the disconnect area and the

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right ventricle in the entry of free wall and the patient has

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a diagnosis of arithmogenic right ventricular dysplasia. Can we

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see the next question? Please pertaining to this case which of

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the following abnormalities a prerequisite for Mr. Fulfillment

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of diagnostic criteria for arvd we have

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five choices here as a participants to vote

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for the best one choice, please.

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Okay, excellent. The majority of the participants answered

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the poor correctly. Akinesia dyskinesia this

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synchronous contractions essential for the diagnosis of arvc. And

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in addition to that one must either have

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a dilated right ventricular depressed rvjection fraction and the

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degree of RV dilatation depends on on whether

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a major criteria used or where they're minor criteria is

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used. It's whether it's a man or a woman in in a

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man in a notched out right ventricular over 110.

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Ml commit square and a woman a hundred.

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Ml per meter Square meets major criteria for RV dilatation

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and injection fraction less than 35% meets

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criteria for for a major Criterion, but

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suggests that the audience refers to their 2010

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updated task force criteria for arvc.

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The finding of I'm going to once again show the four chamber

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view here a can easier discarnation desynchronous

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RV contractions, as you can see in the entry free wall

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of the right ventricle essential for the diagnosis of arvc this

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patient carries a diagnosis of arvc the last

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question pertaining to this case. Can I ask for the poem please?

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Okay, which of the following statements is incorrect? So

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we're looking for an incorrect question incorrect statement

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regarding arvd. Okay, the wrong statement a

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normal cardiacom are excludes diagnosis RVC.

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That's that's a wrong statement patients the diagnosis of

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arvc depends on a number of criteria, which can be derived from

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either genetics ECG family history morphological

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abnormalities, which are diagnosed by

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MRI or

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genetic abnormalities. So in MRI can be normal in arvc yet

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the patient may fulfill criteria for air VC based on

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other criteria. For example, ECG criteria arithmic criteria

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family history genetics.

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So MRI can be normal but a normal

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MRIs is a good prognostic feature in patients with arvc on the

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contrary. If the MRI is extremely abnormal abnormal left

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ventricular function very severely dilated right ventricular

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extensive fibrosis or aneurysms. That's a

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bad prognostic Factor feature and it indicates that the

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patient may likely need an ICD which prevents certain cardiac deaths.

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So the major concern for arv in arvc is sudden

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cardiac death arithmia and certain cardiac death ventricular. Arithm is

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the presence of RV acanisha disc

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on each or disc synchronous contractions as seen in this case essential for

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the diagnosis of arvc. So this case a long

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story patient with arvc or arvd. We

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increasing their fairing to AR VD as arvc because

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we know it's a it's recognize the cardiomyopathy which

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can involve both the right and left ventricles and end stages

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are in some cases are in early case Aries. We see can

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enroll the left ventricle. It's fact in the more

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recently. It's being referred to as earthmogenic cardiomyopathira than

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earthmogenic right hand because left ventricular.

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And also being recognized or in the

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end stages a left ventricle can also be involved arvc first

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case. We've gone to the next case here.