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DCM

added by Emmel

DCM
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Posted By: ohtusabes (969 days ago)

Thats ok Jörg, don´t worry.

In my case I can´t share
quality videos because the US equipment don´t have video recorder...
(remember...we are poor! ahah)

Best
Pablo

Posted By: Emmel (972 days ago)

Hello Pablo!

I am very sorry for my misleading information
in that case. You are absolutely right with your critical comment!!/>In that case we found NO thrombus in LAA and RAA in TEE. After that
I did the electrical cardioversion under therapeutical anticoagulation
(first with UFH then in the following with phenprocoumone). You are
right: NO electrical cardioversion or cardioversion by drugs if the
time of AF is not known or >48 h or in TEE there is no sign of
thrombus. (EXCEPT distinct haemodynamic decrease/ case of
emergency.)
Next time I will give you some more and better
information in my echo-case-reports to avoid misleading.I am very
sorry for that incomplete description of that case.

Best
wishes,
Jörg

Posted By: ohtusabes (972 days ago)

Hi Jörg.

I think that apply electric CV to patients with
AF must follow some rules:
hemodinamic compromise by AF/>acute AF
If data of time of AF is uncertain and you have TEE
and rule out attrial thrombus...no problem with electrical CV too
but....in this case, anticoagulation a cup of weeks is mandatory
because of miocardial stunning and risk of thrombus.
/>Best
Pablo

Posted By: Emmel (972 days ago)

Hello Pablo!

You are very right! In that evaluation there
was no tachycardia any more (HR about 75-85/min). My colleagues gave
that patient beta-blockers and digitoxine to lower heart rate one day
before. The patient was admitted to our ER with haert rate of
140-150/min, so I assume that there could be a Tachy.Cardiomyopathy.
No mitral-stenosis as a reason fpr AF, no myocardial infarction. Maybe
it is a DCM with AF. But there is only a short data of AF of that
patient (about 4 days), is it enough for tachy-CM?
I will
reevaluate that patient whether there is a increase of LV-EF.
/>In my hospital we internists have to do the electrical
cardioversions in ICU or ER. In that case I wanted to enforce the
sinus rhythm (because the patient was very compromised by AF:
dyspnoea, vertigo). I will report wheter there is a increase of
LV-function!!

Best wishes,

Jörg.

Posted By: ohtusabes (975 days ago)

Hello Jörg. Very interesting.

You must think in
tachy-cardiomiopathy in long data AF with heart rate faster than 100,
this is the case?
Post electrical cardioversion (you do it?)
myocardial maybe is stunned...so, control echo must be made aprox. 6
weeks later?

Best my friend
Pablo

Posted By: Emmel (977 days ago)

Hello Pablo!!

Congratulation!! Very, very good
eyeball-estimation of LV-EF! in biplan-simpson-measurement (2C and
4C-view) the LV-Ef was about 30-35%!
You really have an expert
and praticed eye!

The Patient had an atrial fibrillation.
Sorry for the misleading first sequence of that vid (deep transgastric
view: it looks like sinus rhythm). I had to duplicate that deep
transgastric sequence after conversion of that clip in avi-format
because the vid was running too fast after conversion with distinct
lost of quality (I don´t know what actually the problem of my
conversion-software is).
Unfortunately the echocardiographic
device I used for that evaluation has NO
dp/dt-measurement-software.
After making that evaluation I did
the electrical conversion, Actually the patient has a stable sinus
rhythm. I´m anxious to reevaluate that patient, whether the LV-EF
will recover itself (Tachy-Cardiomyopathy ? as a diferential
diagnosis).
Best wishes,

jörg.

Posted By: ohtusabes (977 days ago)

Hi Jörg. Very nice clips!

LV looks dilated and
contractility reduced...35 % aprox. EF? But...with eyeballing at first
look all dilated LV always looks with worse function and at firs look
all small LV looks with better function... So... another contractility
measurement must be done...Simpson, dp/Dt LV, fraccional area change
of LV...to correlate with eyeballing.

In PSAX don´t look
in irregular rythm...sinus rythm restored?

Best my friend
and congratulations again.
Pablo


Video Information
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Emmel

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Added: 18-02-2012
Runtime: 0m 22s
Views: 5005
Comments: 7

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Description

about 50 y old patient with dyspnoea and new diagnosed atrial fibrillation. In TTE we found a distinct decrease of myocardial function. In cardiac catheter there is no coronary disease. Approach to cardiac output by echocardiography: about 3,2 - 3,5 l/min.


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