acute pulmonary embolism
about 90 y old patient mit cyanosis, dyspnoea, tachycardia. In TTE we could see a distinct RV-dysfunction with high elevated pulmonary hypertension (PAPsystolic about 90 mmHg, RAP-approach in respect
to dilatated VCI with no inspiratory collaps about 20 mmHg > RVSP about 100-110 mmHg). systolic and also diastolic septal shift as a sign of RV-pressure and volume-overload; you can also see the
variation of transtricupidal flow dependend on in-and exspiration (inspiratory increase of transtricuspial flow > 45%).
In my opinion there is a acute pulmonary embolism with the underlaying disease of chronic cor pulmonale (RV-Hypertrophie!). With ultrasound we found a thrombosis in lower legs. No CT-scan because of
GFR of about 20 ml/min!
Lysis wasn´t needed till up to now. We started anticoagulation with UFH (aPTT 60-80 sec).
In my opinion you can see the classical McConnel sign (Hyperkinetic RV-Apex with hypo-akinetic lateral RV-wall).
Added: 1969 days ago
Cor pulmonale chronicum
About 70 y old patient with chronic dyspnoea, permanent atrial fibrillation (CHADS-Vasc-Scor 5), actually deterioration of clinical afflictions. A COPD is kown (stage III GOLD)
In TTE and TEE we ccould see a distinct RV-hypertrophy with systolic and diastolic septal bounce (D-sign) as a sign for RV-volume overload and RV-pressure overload (PAPsystolic about 70 mmHg + CVP).
In LAA you can see a distinct echocantrast (thrombus?).
An another interesting finding is a PFO with right-to-left-shunt.
Added: 1906 days ago
inferior ischemic pseudoaneurysm with VSD
about 60 y old patient without typical clinical afflictions of myocardial ischemia (Diabetes type 2 is known: silent ischemia? or only indolent aptient?). The patient was admitted to our ER with
weakness and diarrhoea.
In ECG we found a sign of myocardial infarction stadium I-II in inferior leads, no signs of disturbance in V1-V6. Also we heard a new heard murmur (holosystolic murmur in Erb-point). Blood-sample
showed us distinct elevated liver enzymes (GOT > 1000 U/l, GPT > 800 U/L) and severe disturbance of electrolytes (Na 115 mmol/l, K 5,8 mmol/l); lactate was elevated with 4,8 mmol/l with
In TTE I found a inferior (pseudo-)aneurysm with perforation (VSD) in right ventricle (inferior-septale) with acute leading pressure and secundary volume overload of right ventricle. Overall signs of
acute RV-failure (maybe a myocardial infarction of right ventricle too).
Definitely NO clinical afflictions; NO haemodynamic instability.
Added: 1638 days ago
LV Overload with paradoxical septal motion
In this clip you can see that during systole, the inferior/lateral walls of the LV contract reasonably well, but due to the fluid overload, the septum bows into the RV instead of contracting inward to
the LV lumen.
Added: 3402 days ago
about 85 y old patient with severe acute RV-failure in context of chronic ischemic RV-failure. No sign of pulmonary embolism in initial TEE and ct-scan. First TTE we found a distinct RV-wall movement
disorder. haemodynamic deteriorated rapidly, so we had to start cardiac resusciation for 3 minutes. in TTE we could see a distinct rv-pressure-overload with systolic d-sign. Actually vasopressor and
inotropics save the situation. Any other hints in treatment of acute RV-Failure except inotropics and/ or vasopressor?
Added: 2373 days ago
about 80 y old patient with acute dyspnoea, hypertension and tachycardia; immobile for years. underlaying diseases: arterial hypertension, diabetes mellitus 2, \"high grade\" adiposity. NO
known pulmonary disease (no clinical signs of bronchospasm).
In TTE (sorry for that bad quality) I could see a distinct pressure overload of RV with systolic shift of septum into LV. A classical McConnel-sign wasn´t seen. But in lower legs no thrombosis
(maximum adipositas!). In my opinion that echocardipographic picture with the acute clinical afflictions is compatible with a pulmonary embolism. no ct of lung (kreatinine 3,0 mg/dl); I started UFH
(aPTT 60-80 sec.). no catecholamines needed.
Added: 2001 days ago
RV pressure overload and septal bounce
In this parasternal short axis transthoracic clip, you can see the D shape of the LV common in patients with RV pressure overload. The IV septum also bounces in this particular patient with a history
of sternotomy for aortic valve replacement.
Added: 2414 days ago
RV pressure overload causes D sign
The D sign refers to septal flattening that occurs when right ventricular pressure is so elevated that it deforms the left ventricular cavity which usually remains in a doughnut or O shape, as in this
parasternal short axis TTE clip.
Added: 3228 days ago
Septal bowing from RV pressure overload
This apical TTE clip shows a patient with severe RV pressure elevation that has resulted in the ventricular septum bowing into the LV chamber (seen on right side of clip)
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Added: 3197 days ago
Severe RV dysfunction on apical TTE
This apical clip demonstrates single ventricle dysfunction quite nicely. Note how the left ventricle contracts very well, but the right does not. This patient has severe RV pressure overload of
unknown etiology at this time.
Added: 3364 days ago
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Added: 3367 days ago