Chronic cardiorenal syndrome

Case contributed by Karen Machang'a
Diagnosis certain

Presentation

Known hypertensive with end stage renal disease (ESRD) on hemodialysis presents with dyspnea, shortness of breath and fluid overload

Patient Data

Age: 50 years
Gender: Male
x-ray

There is bilateral lower zone pulmonary infiltrations with upper lobe pulmonary vascular congestion.

The heart is enlarged. The aorta is unfolded. There are small bilateral pleural effusions.

Thoracic bony cage is normal.

ultrasound

Severe left ventricular hypertrophy (LVH), both the interventricular septum and posterior wall measures >2cm in diastole.

Impaired Left ventricular systolic function, LVEF 30-35%. Mild mitral regurgitation.

Dilated right cardiac chambers, the right atrium is grossly dilated measures 45cm2 compressing the left atrium and the left ventricle is D-shaped (flattening of the interventricular septum) secondary to right ventricular volume overload and increased pressure.

Severe eccentric tricuspid regurgitation with severely elevated pulmonary pressures estimated sPAP >70mmHg.

Grossly dilated IVC with less than 50% collapse during inspiration. Hepatic vein flow is all diastolic, no systolic forward flow a sign of raised right atrial pressure;20mmHg.

Moderate pericardial effusion.

There is patchy left basal consolidation/atelectasis.

Moderate bilateral pleural effusion, right more than left.

Cardiac configuration and size appear enlarged with circumferential pericardial effusion.

No mediastinal mass or adenopathy is demonstrated.

Case Discussion

This is a cardiorenal syndrome (type IV) case where chronic renal disease is associated with cardiovascular injury. Cardiac workload is increased in chronic renal disease resulting in left ventricular hypertrophy, pressure overload and volume overload.

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