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acute pulmonary embolism

added by Emmel

acute pulmonary embolism
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Posted By: Emmel (640 days ago)

Haqllo Narjis,
unfortunately I don´t know this book. I think the
most helpful book is a book that desbribes the standard
echocardiographic procedures and echocardiographic measurements in the
ECHO-Lab. In my opinion all manufacturers use the same modalities in
measurements. Maybe that book could be very helpful for differention
between the manufacturers. I only know books in german language and
the german, the european and american "guidelines" of echocardiography
("what is requested in doing echo".)The handbook of your echo-machine
could also be helpful, how to use your echo-machine.
In my
opinion a "how-to-do"-/"checklist"- or "echo-guide"-book is the most
helpful book.
Best wishes and greetings,
Jörg

Posted By: sdraza1 (642 days ago)

Sorry I have an unrelated question as I don't know how and where to
post a question.
There is a book being sold on eBay with the
title 'Performing echocardiographic studies using machines of Major
Manufacturers'.
In the description it is written that the book
describes working with 11 different US machines. Has anybody used this
book, is it a good book? As I am new in echo I think it can be very
helpful for me.
thanks

Posted By: Emmel (659 days ago)

Hello Pablo,

We didn´t do a ct-scan, because of GFR about
20ml/min, but I could see a thrombosis of lower limbs, because of that
I started treatment of pulmonary embolism/ thrombosis with UFH. A ct
would be very interesting whether there is a CTEPH (type 1 or type 2),
that could be a indication for surgery (NYHA III-IV, PAPm >> 45 mmHg,
PVR-approach with "Echodynamik" about > 450 dyn*sec*cm^5), but that
patient is too old (90y) and weak for that indication.
I think it
is very likely to CTEPH, because of very high RVSP, diagnosed
thrombosis and high transpulmonry gradient (approach > 12 mmHg)./>Best wishes and greetings and thanks a lot for comment,
Jörg

Posted By: ohtusabes (662 days ago)

Thinking in CTEPH...do you have angio-CT scan of thorax or duplex deep
vein analysis?

Posted By: Emmel (662 days ago)

Thank you very much for comments!
Actually I think in respect to
the previous findings, that there is a acute pulmonary embolism on top
of chronic RV-Dysfunction (RV-Hypertrophy, previous PAPsystol. of
about 50 mmHg + CVP), but there is no known pulmonary disease (nor
COPD etc.). Maybe there is a CTEPH as the underlaying disease./>Best wishes and thanks a lot for comment,
Jörg

Posted By: drdavemd (663 days ago)

I guess no sign of PE in the short axis RVOT view? This would be the
person you might actually see that in. Certainly one of the highest
RVSPs I have seen.

Posted By: ohtusabes (664 days ago)

Great clip Jörg. Amazing RV inflow/outflow view!
There is some
posterior pericardial effusion...associated with chronic pulmonary
hypertension. RV outflow tract is akinetic too...


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Added: 24-02-2013
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about 90 y old patient mit cyanosis, dyspnoea, tachycardia. In TTE we could see a distinct RV-dysfunction with high elevated pulmonary hypertension (PAPsystolic about 90 mmHg, RAP-approach in respect to dilatated VCI with no inspiratory collaps about 20 mmHg > RVSP about 100-110 mmHg). systolic and also diastolic septal shift as a sign of RV-pressure and volume-overload; you can also see the variation of transtricupidal flow dependend on in-and exspiration (inspiratory increase of transtricuspial flow > 45%). In my opinion there is a acute pulmonary embolism with the underlaying disease of chronic cor pulmonale (RV-Hypertrophie!). With ultrasound we found a thrombosis in lower legs. No CT-scan because of GFR of about 20 ml/min! Lysis wasn´t needed till up to now. We started anticoagulation with UFH (aPTT 60-80 sec). In my opinion you can see the classical McConnel sign (Hyperkinetic RV-Apex with hypo-akinetic lateral RV-wall). Any comments?


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