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pulmonary embolism

added by Emmel

pulmonary embolism
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Posted By: Emmel (584 days ago)

Hello Pablo!

Unfortunately we will not experienced what the
underlaying problem is in that case. The patient doesn´t want any
diagnostic. The giviing of some diuretics has advanced the clinical
afflictions. Over all I think you´re absoloutely right with
combination of CTEPH and LAE and I´ve to confess that there is a
diastolic overload. Watching this vid for the first time I haven´t
seen this sign.
Best greetings,

Jörg.

Posted By: ohtusabes (587 days ago)

Hi Jörg.

Sorry about LMWH question...in this case it is
recommended UFH like you do...

Is there diastolic overload,
too?

I think, like you say, the most probably diagnosis is
CTEPH and acute embolic event, and this is more probably because RVSP
is high and in acute pulmonary embolism RV is not adapted to elevate
RVSP.

Great clip.
Best

Posted By: Emmel (587 days ago)

Hello Pablo!

The diagnosis of thrombembolism was in that
case for me the only plausible. There was acute beginning of symptoms
(not really typical for CTEPH, but you´re right, it could be an acute
decompensation of CTEPH): but maybe acute new embolism and preexisting
CTPEH.
The RVSP was about 55-60 mmHg (PAPs 40-45 mmHg + CVP of
about 15 mmHg > approach by measurement the VCI-collaps); no LBBB or
RBBB > width of QRS was about 100 msec.
The existimated GFR
(MDRD-formula) was about 15-20 ml/min/1,73 qm KÖF), so I decided to
give UFH, because in germany no LMWH is licensed by EMAH or german
drug administration (I think so, please correct me, if there is
something new in using LMWH in patients with kidney insufficiency).
Ok, you can measure the factor-anti-Xa (that is the term in germany, I
don´t no the "real" international term of measurement of LMWH-effect)
to control LMWH-effect but this is not very practicable
(aPTT-measurement needs about 10 to 15 minutes, LMWH-measurement needs
ablut 2-3 hours in my hospital).
best wishes,
Jörg.

Posted By: ohtusabes (587 days ago)

Sorry for question about LMWH...you mentioned a Creatinine of 3 mg%

Posted By: ohtusabes (587 days ago)

Hi Jörg.

IVS looks with flattening in systole and
dyastole...so...a RV of systolic and diastolic overload exists. (In
EKG there was LBBB?)

For RV systolic your diagnosis of TE
or maybe CTEPH and for RV diastolic overload?...severe tricuspid
regurgitation?

RV systolic pressure was?

Other
question: why don´t you use LMWH in this patient?

Best
wishes...great clip!


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Emmel

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Added: 23-01-2013
Runtime: 0m 7s
Views: 6991
Comments: 5

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Description

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.


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