This patient is a 61 year old female with a history of hypertension and diabetes who presents with 3 weeks of intermittent exertional left sided chest pain. The pain is dull, non-pleuritic, always comes on when walking around and resolves with rest. +shortness of breath. Vitals: 95/50 125 22 98.6 97% RA. What diagnosis is suggested by the following bedside echo, and what can be measured to clinch the diagnosis?
Right ventricular dilatation and dysfunction, consistent with pulmonary embolism.the ECG also suggest the same diagnosis: sinusal tachycardia,Q3T3, right precordial T negative waves consistent with right ventricular strain
The useful blood test is D-dimer
Disagree with Ezio. D dimer in this context adds little after the ECHO
Risk is now very high, dimer cannot rule out here
of course I agree, D-dimer does not rule out, I did not mean that!
I misunderstood the question “what can be measured”, as a blood test. In this case an useful echo measure is the PAPS: if less than 60mmHg it confirm that the right ventricular dilatation and dysfunction are acute
Please comment on RV movements
Please comment on RV function and wall movements
Hi Dear Coleagues,
RV is dilated and in strain; I can not measure TAPSE of course but it seems to be small; now I can measure Tricuspid Regurgitation and if it is more than 2.5 m/s then we have significant PAP(bernouli formula 4V^2)and if the RV wall is less than 6 mm then we have acute corpulmonale most probably due to PTE.
McClonnelle’s sign with relative preserved right ventricular apex contractility with dilated RV and dyskinesia of RV lateral wall and D shape on PSX view on echo