UOTW #65

This 56 year old smoker with a history of HIV and anal cancer presents with complaints of 1 month of gradual onset severe shortness of breath, much worse for the past week. Vitals: 82/46 130 98.6F 30 75%RA.

Answer

4 thoughts on “UOTW #65

  1. Dear Ben,
    I see some clots in RA; Am I right?The RV is not hypertophic;Why cardiogenic shock?The LV function seems good;The obstructive shock is more compatible with this patient!

    1. I think the echogenic material in the RA is just some agitated bubbles being infused in the IV line. Great point about obstructive shock vs cardiogenic. The RV is failing miserably here, reducing the LV preload to near nothing (and preventing the left heart from filling via ventricular interdependence). The treatment for this condition would include reversal of the hypoxia (helping to dilate some of the pulm vascular bed), and possibly inhaled NO and a PDE. All of these treatments are aimed at resolving obstructive physiology. Early on in the treatment course, I’d probably use norepi to augment RV function – and this is directed at the cariogenic portion of the hypotension equation.

  2. Great clip. The right atrial mass could be chiari network since its not protruding to RV.. it seems not an acute process rather a chronic or acute on top of chronic pulmonary htn. .in acute PE, the TRV rarely exceeds 3m/s producing just mild pulmonary htn since the RV is not conditioned to do so

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