Many systemic diseases can involve the heart and result in cardiac dysfunction. In addition, treatment of some diseases, such as cancer, may adversely affect cardiac structure and function. Several of these conditions have been discussed in other sections of this atlas (eg, pericardial disease from malignancy, chemotherapy-related cardiomyopathy, cardiomyopathy related to muscular dystrophy, systemic amyloidosis).
In this chapter, Drs. Brinkman, Sharma, and Evanchan briefly present a few cases to highlight the role of echocardiography in other selected systemic disease states.
SECTION 1: HYPERTENSIVE HEART DISEASE
CLINICAL CASE PRESENTATION
A 50-year-old man presented to the Ohio State University Medical Center for evaluation of elevated blood pressures noted at a routine eye appointment. He had been told of high blood pressures for at least the last 5 years, but he had not been established with a primary physician at the time and did not seek out medical attention. He recently became established with a primary physician and was noted to have a blood pressure greater than 170/110 mm Hg on repeat evaluations. He was on no medications at the time and otherwise denied any symptoms. His exam was normal other than the elevated blood pressure and a faint S4 gallop heard on exam. His creatinine was mildly elevated (1.4 mg/dL), and an ECG showed borderline LVH by voltage criteria. He was reluctant to start any medications and was referred for an echocardiogram. This revealed moderate concentric hypertrophy of the left ventricle (Figures 12-1-1 and 12-1-2), a mildly dilated aortic root (Figure 12-1-3), left atrial enlargement (Figure 12-1-4), and grade II diastolic dysfunction (Figures 12-1-5 and 12-1-6). He agreed to start medical therapy and subsequent blood pressures have been normal at clinical visits.
Parasternal long axis view of the left ventricle showing concentric hypertrophy of the left ventricle. The septal thickness measures 1.9 cm with a posterior wall thickness of 1.8 cm ▶ (see Video 12-1-1).
Video 12-1-1: Parasternal long axis view showing concentric hypertrophy of the left ventricle. The septal thickness measures 1.9 cm with a posterior wall thickness of 1.8 cm.
Parasternal short axis view demonstrating concentric left ventricular hypertrophy ▶ (see Video 12-1-2).
Video 12-1-2: Parasternal short axis view demonstrating concentric left ventricular hypertrophy.
Parasternal view of the ascending aorta, which is mildly dilated (4.0 cm).
Apical 4 chamber view showing left atrial enlargement.