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Clinical introduction A patient in their 30s had been diagnosed with peripartum cardiomyopathy, pulmonary oedema, with severe left ventricular dysfunction at the seventh month of gestation in the third pregnancy in their late 20s. Echocardiogram, CT aortogram and late gadolinium imaging of the aorta have been shown in figure 1.
CT of the chest showed no pulmonary embolism but bibasilar infiltrates. Finally, do a coronaryangiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. She was intubated. Bedside cardiac ultrasound showed moderately decreased LV function. Dobutamine is an acceptable alternative.
Echocardiogram is indicated (Correct) C. Start aspirin and Plavix Correct answer: (B) (B) Echocardiogram is indicated. Which of the following is the best statement to describe further clinical management? No further workup is indicated B. Start furosemide for diuresis D. Start with a Free Trial.
He visited an outpatient clinic for it and an echocardiogram and exercise stress test was normal. On his physical examination, cardiac and pulmonary auscultation was completely normal. Bi-phasic scan showed no dissection or pulmonary embolism. He has 40 packs-year of smoking history. He denies taking any medication.
The diagnostic coronaryangiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Aortic angiogram did not reveal aortic dissection. The patient was transported to the CCU for further medical optimization where a pulmonary artery catheter was placed.
I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Anything that causes pulmonary edema: poor LV function, fluid overload, previous heart failure (HFrEF or HFpEF), valvular disease. Or I suspect that there is OMI simultaneous with another pathology.
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