Monday, December 23, 2013

Hot to Quickly to estimate Blood Pressure By Pulse ( Pulse Site=Specific BP Range) ?

ICCU duty interesting cases ! ( Acute Pul.Embolsim )

A 30 years old man brought to ICCU by complain of new onset severe dyspnea without PND, Orthopnea , chest pain ....etc
W/o any history of DVD and leg swelling and long time bed rest which he was physically active BP 90/60 , HR 150 , RR-28 , no any other considerable addiction and family history of CAD and Blood test not shown hypercoagulable state, CXR had not considerable changes still , D dimer was not match to disease , after ECG shown typical view of PE and echo shown RV and RA dilatation, RV dysfunction , severe pul.hypertension , and pulmonary artery thormbosis recorded and CT angiography . but extremity doppler was not documented any clod and occlusion . After tPa infusion over 2 hours he compeletly calm and HR decreased and dyspnea slowly resolved .
Typical ECG of PE :
the most specific finding on an ECG is the classic S1Q3T3 pattern , but the most common finding non-specific ST-segment and T-wave chages.
Other coomonly reported findings include sinus tachycardia , Right bundle branch block .
Like chest radiography , the major utility of ECG is the diagnosis of PE is to rule out the other major diagnosis such as acute MI .

Tuesday, December 17, 2013

Cardiogenic Shock due to Acute MI with Preserved Ejection Fraction !

In these days humming of Heart failure with preserved EF peaked in the skies, but once we know from our primitive studies from medical school which Cardiogenic shock is the advanced form of severely LV/RV dysfunction ,  but there are some causes which having  the EF preserved of LV disorder . 

from our primitive studies we know which the following causes are those causes of CS which may have preserved the EF , Although , In inferior and Posterior wall MI , not only one ventricle involves , here we have both ventricular disorder which prompt PCI and IABP rescued the patient : 

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