Aortic Stenosis Detected by HART, but Normal ECG

 

Situation

A symptomatic female patient of 72 years, 152cm, 76kg, was recorded with CHART in primary care because cardiovascular disease is suspected by symptoms.

 

CHART Report Interpretation

 

Risk Assessment

• 72 year, BMI = 33kg/m2, normal blood pressure 125/80

• No alcohol, no smoke, no allergies,

• take more medications.

 

HART-Findings and HF prediction

Abnormal HART summary:

• Abnormal AV stenosis,

• Mild diastolic dysfunction,

• and mild AV insufficiency.

HF prediction:

• Estimated LVEF = 66%

• Consider HFpEF

• Consider BNP test to confirm HF

 

 

ECG

ECG is normal. Sometimes valve diseases do not cause any abnormality in ECG.

 

 

PCG

PCG is abnormal because of a holo-systolic murmur, which indicates aortic-mitral stenosis.

 

MCG

MCG systolic time intervals are normal, which indicates normal systolic function.

Typically ECG and STI methods were blind for valve diseases without significant systolic dysfunction.

 

Decision Support

CHART decision support outcome: Send this patient to cardiology for further diagnosis and treatment with routine priority.

 

 

Echocardiographic Results

Combined aortic-mitral defect with moderate aortic stenosis (AVpV=3.5m/s) and thickened posterior mitral leaflet.

Borderline concentric LV hypertrophy (IVSd=11mm, PWd=10mm, LVMI=110g/m2).

Preserved LV systolic (LVEF=69%) with mild diastolic dysfunction of impaired relaxation (E/A=0.85).

Other parameters: LAVI=14 ml/m2, RAVI=18ml/m2, RVSP = 20mmHg

The patient has HFpEF and should refer to cardiology from primary care.

 

Conclusion

The patient has HF symptoms due to an aortic valve defect.

The correct type of HF prediction by CHART.

Correct LVEF estimation by CHART.

The prediction of valve diseases and diastolic dysfunction are correct, confirmed by ECHO.

The borderline LVH could not be detected by ECG or CHART bio-signals for this patient.