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💌#سوال هفته شماره ی 111

✳️⁉️ACC #Patient Case Quiz

- A 42 years old female with a medical history significant for type 2 diabetes mellitus
- Presented to the hospital with a 1-week history of new-onset exertional dyspnea.
- Vital signs: BP 118/72 mmHg, HR 92 bpm, and O2 saturation of 98% (2L nasal cannula).
-Initial physical exam: largely unremarkable, with the exception of jugular venous distention estimated at 12 cm of water.
- Chest X-ray: negative for any acute process.
- CTA: central pulmonary emboli present in both pulmonary arteries & in sub-segmental branches of the right upper lobe, right middle lobe, and both lower lobes (Figure 1).
- The right ventricle/left ventricle ratio was calculated at 1.7.
- Transthoracic echocardiogram: a large, mobile right atrial (RA) thrombus measuring 4.3 x 2.2 cm (Figure 2A).
- Significant right ventricular dysfunction and severely elevated pulmonary artery (PA) pressure >90 mmHg with normal left ventricular and left atrial size and function (Figure 2B).
- Troponin was <0.01.
Figure 1

What are the correct diagnosis and the most appropriate next step in this #patient's treatment?


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🚩#Quiz Of The Week

* ESCardioEd challenge by Pierre Baudinaud et al., Hospital La Pitié Salpétrière, Institute of Cardiology, – Paris.

✳️A 42-year-old Caucasian male presented to the ER with exertional dyspnea and asthenia with 2 weeks duration. ECG showed a complete AVB with a junctional escape rhythm at 29 bpm. The patient lived in Cameroon, Mexico and in Asia. He had returned to France 2 months prior. His past medical history was malaria in 2016, giardiasis in 2016, amoebiasis, a streptococcal skin infection in 2014, conjunctivitis ten years ago and a bacterial meningitis in 1998. He didn’t have any medication at home nor drug consumption. No familial history was found. He received 2mg of atropine without success and was referred to the EP Intensive Care Unit. The standard laboratory tests were unremarkable. Autoimmune profiles, serologies and quantyferon were negative, the Angiotensin-converting enzyme level was low. The biopsy of the accessory salivary gland was normal. The transthoracic echocardiography at admission was normal.
EPS below. Where is the block?
A. AV node block
B. No conduction block
C. Intra Hissian block
D. Infra Hissian block

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