cardial decompensation
added by Emmel
cardial decompensation
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Video Information
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Added: 18-02-2012
Runtime: 0m 31s
Views: 10783
Comments: 3 Current Rating:
(1 Votes)
Runtime: 0m 31s
Views: 10783
Comments: 3 Current Rating:
(1 Votes)
Description
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.
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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Hello Jörg.
/>if you measure 35 mm... the pleural effusion is about 700 ml... />
I have a data about pleural effusion
quantification:
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:
Best
Pablo
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.
No
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!
Jörg.
Hello my friend. Very very good clip. Congratulations.
/>
/>Pablo
The
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.