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cardial decompensation

added by Emmel

cardial decompensation
Posted By: ohtusabes (2333 days ago)

Hello Jörg.

I have a data about pleural effusion

Measure the distance between lung base and
diaphragm (in milimeters) and multiplye by 20... know you have the
estimated volume of the pleural effusion.

For example:/>if you measure 35 mm... the pleural effusion is about 700 ml... />

Posted By: Emmel (2336 days ago)

Hello Pablo!

You are right, there is a atrial kick! (Very
good look by you!!) In clinical history there is a permanent
brady-arrhythmia absoluta and condition after
VVI-pacemaker-implantation. I THINK that is a wrong information. I
think it is a VDD-pacemaker. I could measure an E- and A-velocity so
there must be a sinus-rhythm. So I think there is a paroxysmale AF and
a high-grade AV-blockade.

I assume there is a postcapillary
PH (PH type 2) AND a PH (type 3; lung deaseases). The patient has a
COPD by condition after chronic nikotin-consumption, but no specific
inhalative therapy. So I think there is a distinct chronic lung
problem. But to evaluate this we have to do a PA-cath.
hyponatriaemia (Na 136 mmol/l), but that don´t speak to the contrary
of hyperaldosteronism as the underlying mechanism of that distinct
pleural effusion. In this case I think the patient has a profit by
aldosterone or eplerenone.

By the way: I have done a
tapping of pleural effusion and have given that patient loop
diuretics. After 5 days in echocardiography: LVEDP about 16 mmHg and
RVSP about 50 mmHg and a distinct improvement of clinical symptoms,
but no increase of LV-EF.

Thanks a lot once more for
helpful comments!


Posted By: ohtusabes (2339 days ago)

Hello my friend. Very very good clip. Congratulations.

leads of PM in RV are seen very nice!

Do you measure
mitral inflow pattern just when atrial kick find open MV and E and A
wave or just when patient was in sinus rythm?

LV function
looks very depressed... PHT is postcapillary alone or patient have
chronic lung problems?

The US B lines are great! and
pleural effusion tell you about chronic cardiac failure and secundary
hyperaldosteronism!. If this patient hyponatremic? it is probably!/>
Amazing my friend, your approach is really good.

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Added: 18-02-2012
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about 80 y old patient with dyspnoea. The patient was admitted to our internal ER from surgical ward. Condition after implantation of VVI-pacemaker in context of bradyarrhythmia absoluta (actually the patient is pacemaker-dependent). In TTE we found us-b-lines and distinct pleural effusion right. There was alos a distinct decrease of cardial function, a severe pulmonary hypertension (RVSP about 65 mmHg) and a disorder of LV-compliance (approach to LVEDP about 20 mmHg; DecT 180 msec, E7A 2,3, E-velocity about 1 m/s, E`-velocity 0,5 m/sec, E/E´about 20 mmHg, Velocity-prolongation about 0,36 m/sec). IVC 19-20 mm without undulation.

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