Sharqiyah Echo Club Sharqiyah Echo Club

Anwar JelaniKing 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

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

Echo?

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.