cardiogenic shock caused by thrombembolic occlusion of left main stem
added by Emmel
cardiogenic shock caused by thrombembolic occlusion of left main stem
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Added: 17-01-2012
Runtime: 0m 19s
Views: 4158
Comments: 2 Current Rating:
(2 Votes)
Runtime: 0m 19s
Views: 4158
Comments: 2 Current Rating:
(2 Votes)
Description
about 75 y old patient with STEMI and about 45 minutes cpr. the patient was admitted from our ER after cardiac catheter to our ICU. In cardiac catheter we found a thrombotic occlusion of left main stem, no plaques and no stenosis. in clinical history a permanent atrial fibrillation with condition after several thrombembolic strokes is known. in TEE we found a distinct cardiac wall movement disorder of left ventricle and a small parietal residual of thrombus in LAA. we think that a thrombembolic cardiac infarction caused by thrombus in LAA is the most plausible reason of this finding.
about 75 y old patient with STEMI and about 45 minutes cpr. the patient was admitted from our ER after cardiac catheter to our ICU. In cardiac catheter we found a thrombotic occlusion of left main stem, no plaques and no stenosis. in clinical history a permanent atrial fibrillation with condition after several thrombembolic strokes is known. in TEE we found a distinct cardiac wall movement disorder of left ventricle and a small parietal residual of thrombus in LAA. we think that a thrombembolic cardiac infarction caused by thrombus in LAA is the most plausible reason of this finding.
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Hi Diego! Thanks for comment! It´s very nice t hear from you
again!
You´re totally right!
We found an aortic
gradient in TTE (PGmean about 15 mmHg !!!!, ejection fraction < 20%;
besides a small central regurgitation jet as a sign of aortic
insufficiency). PGmean aof 15 mmHg with that EF, that could be a sign
of high-grade aortic stenosis: I didn´t evaluate aortic gradients
with the continuity equation because I measured too different
LVOT-diameters.
In TEE I couldn´t achieve a good deep
transgastric position to measure and evaluate the aortic gradients,
but one can see in that clip a distinct sclerotic cups of aortic valve
(so you´re right!!).
I´m under the impression that only the
left-coronary cup shows a movement. Unfortunately we had NO latest
results of clinical history, so I don´t know whether the patient had
a high-grade stenosis of aortic valve before.
Overall this case
was a "disaster"! We couldn´t rescue the patient. IABP 1:1, high-dose
norepinephrine and dobutamine, pitressin, levosimendane, milrinon and
amiodarone couldn´t achieve a stable clinical situation. Lactate
about 5-8 under CVVHDF!
In PA-cath: SVR 430 dyn*sec*cm^-5, CO
3,2 l/min, cardiac power 0,42!!! The patient was in a deep cardigenic
shock.
Hi jorg long time no see :) Nice clip really...... tell me something
about AORTIC GRADIENTS . Did you evaluate aortic flows? It seems that
at least 2 of the 3 aortic cusps are really stiff so to speak . Could
you evaluate aortic flow in deep transgastric view?
ciao