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BackgroundDespite the poor outcomes related to the presence of pulmonary hypertension, it often goes undiagnosed in part because of low suspicion and screening tools not being easily accessible such as echocardiography. Each 15second PCG, recorded using a digital stethoscope, was processed to generate 5second melspectrograms.
link] Briefly, this woman without significant cardiac history went into pulmonary edema with respiratory failure. I refer you to the video case presentation by one of my colleagues, Dr. Rob Reardon (who has, by the way, a fantastic collection of ED ultrasound cases). The apparent trigger was stress from losing custody of children.
After discharge, she was scheduled for a 2-week postpartum visit including echocardiogram, EKG, and NT-proBNP.Discussion:Given the patient's acute decompensation and fluid overload, medical optimization was essential prior to delivery. However, stabilization was expected to be temporary due to ongoing physiologic changes of pregnancy.
A transthoracic echocardiogram showed an LV EF of less than 15%, critically severe aortic stenosis , severe LVH , and a small LV cavity. The patient was transported to the CCU for further medical optimization where a pulmonary artery catheter was placed. Any alteration in physiology can change "compensated" AS to "decompensated" AS.
Cardiac enzymes, CTs, echocardiograms, carotid ultrasounds, and electroencephalography all affected diagnosis or management in Postural blood pressure , performed in only 38% of episodes, had the highest yield with respect to affecting diagnosis (18-26%) or management (25-30%) and determining etiology of the syncopal episode (15-21%).
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