Sharqiyah Echo Club Sharqiyah Echo Club
Anwar JelaniKing Abdulaziz Hospital, Alhasa
[email protected]
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
110 bpm irregularly irregular
82% on RA
37.4 C.
Elevated JVP
Resp Crept (loud)
Ascites and LL edema up to the knees
Hb: 112WBC: 13Plt: 327
BUN: 23Creat: 240BNP: 140Trop: 0.57
What are your findings?
LVH
Good LV systolic fx
MR ++
LA enlargement
TR +++
RV dilated
RV volume overload
RV pressure overload
What do you think is going on?
What would you like to know more?
How would that affect your management?
Now, what is your working diagnosis at this moment?
How would you mange the patient at this time?
What will you plan?
Admitted.
Lasix and Abx.
TEE
ASD
TR
Pulm HTN (severe+)
Dx?
Treatment?
Intervention?
Prognosis?
Consulted pulmonary
IV diuresis.
INR
And discussed the further management.
endothelin receptor antagonist.
competitive antagonist of endothelin-1, at ET-A and ET-B receptors.
Bosentin.
Follow up in the OPD.
Symptoms improved in sense of NYHA.
Readmitted every few months when ran out of Bosentan.
Thank you for your attention.