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During her doctoral research, Esther Maas investigated the use of new ultrasound techniques to image dangerous aorticaneurysms for patient-specific care.
Inverse probability weighting was used to assess the impact of IVUS on a composite outcome of repeat aortic intervention or death. Circulation: Cardiovascular Interventions, Ahead of Print. Cox regression was used to estimate weighted hazard ratios.RESULTS:A total of 136 540 patients underwent TEVAR and EVAR, of which 9.8% (13 364) used IVUS.
An intra-aortic balloon pump was placed, and the patient was taken for immediate surgical repair but did not survive. If detected early by ultrasound, the patient can be saved. Additionally , these patients have a high incidence of LV aneurysm with mural thrombus. 3) Oliva et al. (4)
CT angiogram chest: no aortic dissection or pulmonary embolism. Repeat CT angio chest (not CT coronary, unclear what protocol) showed possible LAD aneurysm and thrombus. Beware a negative Bedside ultrasound. No further troponins were measured. Serial chest xrays: progressive bilateral pulmonary edema. Pericarditis?
An elderly patient with a ruptured abdominal aorticaneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." A bedside ultrasound was done by the emergency physician, using Speckle Tracking. What do you think?
Rob Simard discusses one of the most important uses of POCUS in the ED, and that is for AAA. He reviews the literature on the accuracy of POCUS for AAA as well as demonstrates the limitations and the common pitfalls in this POCUS Cases video.
Look for Vascular Etiology -- think of these while doing H and P: --Bleeding: ruptured AAA, GI bleed, ruptured ectopic pregnancy, other spontaneous bleed such as mesenteric aneurysms. Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. heart auscultation (aortic stenosis); c. orthostatic vitals b.
AorticAneurysms : An aneurysm is an abnormal bulge in a blood vessel wall. Vasculitis : Inflammation of blood vessels that can lead to organ damage or an aneurysm. Our Diagnostic Services Include: Vascular Ultrasound Tech Services : Non-invasive imaging to assess circulation and detect blockages.
There are no Q-waves to suggest old inferior MI, or inferior aneurysm as the etiology of the ST Elevation. I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Smith : "decompensation" of aortic stenosis might have initiated this entire cascade.
Case continued A bedside cardiac ultrasound revealed grossly preserved left ventricular function, no appreciable wall motion abnormality, pericardial effusion, or obvious valvular abnormality. The terminal part of the T-wave is inverted in lead III, and reciprocally terminally upright in lead aVL. Another EKG was also obtained.
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