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Sharqiyah Echo Club

Sharqiyah Echo Club. Anwar Jelani King Abdulaziz Hospital, Alhasa JelaniA@ngha.med.sa. 72 year lady known case of HTN, DM came to ER. S.O.B for 5 days. Cough and sputum LL swelling worsening. Chest tightness, sputum,. Warfarin, Furosemide, Metoprolol, Lisinopril. O/E 104/59

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Sharqiyah Echo Club

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  1. Sharqiyah Echo Club Anwar Jelani King Abdulaziz Hospital, Alhasa JelaniA@ngha.med.sa

  2. 72 year lady known case of HTN, DM came to ER. • S.O.B for 5 days.

  3. Cough and sputum • LL swelling worsening. • Chest tightness, sputum,

  4. Warfarin, • Furosemide, • Metoprolol, • Lisinopril

  5. O/E 104/59 • 110 bpm irregularly irregular • 82% on RA • 37.4 C.

  6. Elevated JVP • Resp Crept (loud) • Ascites and LL edema up to the knees

  7. Hb: 112 • WBC: 13 • Plt: 327 • BUN: 23 • Creat: 240 • BNP: 140 • Trop: 0.57

  8. Echo?

  9. What are your findings?

  10. LVH • Good LV systolic fx • MR ++ • LA enlargement

  11. TR +++ • RV dilated • RV volume overload • RV pressure overload

  12. What do you think is going on? • What would you like to know more? • How would that affect your management?

  13. Now, what is your working diagnosis at this moment? • How would you mange the patient at this time? • What will you plan?

  14. Admitted. • Lasix and Abx. • TEE

  15. ASD • TR • Pulm HTN (severe+)

  16. Dx? • Treatment? • Intervention? • Prognosis?

  17. Consulted pulmonary • IV diuresis. • INR • And discussed the further management.

  18. endothelin receptor antagonist. • competitive antagonist of endothelin-1, at ET-A and ET-B receptors. • Bosentin.

  19. Follow up in the OPD. • Symptoms improved in sense of NYHA. • Readmitted every few months when ran out of Bosentan.

  20. Thank you for your attention.

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