📚📖#آموزشی : 📚📖
🚩#Quiz Of The Week
* #ESCardioEd challenge by Pimpimol Yooprasert and team, Faculty of Medicine Ramathibodi Hospital, Mahidol University - Bangkok
✳️A 22-year-old, 34 weeks pregnant, was referred due to massive hemoptysis.
Personal history: first episode when aged 17 and 7 months pregnant, patient gave birth to a preterm baby who died 2 weeks later of unknown cause, no autopsy.
Five months prior to this admission, she had hemoptysis and acute dyspnea after traveling on a long-distant bus and diagnosed with pneumonia.
Examination: Tachypnea with desaturation, diagnosed with heart failure. Pulse oximetry measured from her left hand showed a saturation of 91 % on room air, and 96 % while on 10 LPM oxygen mask. There was no central or peripheral cyanosis and no clubbing of fingers or toes , but pulse oximetry showed more degree of desaturation of her feet, measured 74 %. On auscultation, there was loud P2 and pansystolic murmur grade III/VI at left lower parasternal border area. Lungs were clear and minimal pedal oedema was noted.
Chest x-ray: cardiomegaly, enlarged pulmonary trunk and right pulmonary artery, increased pulmonary vasculature, and a patchy infiltration at left upper lung zone. ECG: normal sinus rhythm with evidence of right ventricular hypertrophy and right axis deviation.
Blood test: mild normocytic anaemia (Hb 11.4 g/dL, Hct 38.0 %, MCV 81.7 fL), thrombocytopenia with platelet count 88000 /mm3, and normal white blood cell series.
🔸Echocardiogram is below.👇
🔻What would you do next?
A. Emergency baby delivery
B. Right heart catheterization
C. Counseling with multidisciplinary team
D. Bedrest and therapy until delivery
📄📄در #نظرسنجی شرکت کنید 📄📄
📌#پاسخ فردا در همین کانال 👇
🖥 https://bit.ly/2MbSCQz
✨ Join Us✨
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🚩#Quiz Of The Week
* #ESCardioEd challenge by Pimpimol Yooprasert and team, Faculty of Medicine Ramathibodi Hospital, Mahidol University - Bangkok
✳️A 22-year-old, 34 weeks pregnant, was referred due to massive hemoptysis.
Personal history: first episode when aged 17 and 7 months pregnant, patient gave birth to a preterm baby who died 2 weeks later of unknown cause, no autopsy.
Five months prior to this admission, she had hemoptysis and acute dyspnea after traveling on a long-distant bus and diagnosed with pneumonia.
Examination: Tachypnea with desaturation, diagnosed with heart failure. Pulse oximetry measured from her left hand showed a saturation of 91 % on room air, and 96 % while on 10 LPM oxygen mask. There was no central or peripheral cyanosis and no clubbing of fingers or toes , but pulse oximetry showed more degree of desaturation of her feet, measured 74 %. On auscultation, there was loud P2 and pansystolic murmur grade III/VI at left lower parasternal border area. Lungs were clear and minimal pedal oedema was noted.
Chest x-ray: cardiomegaly, enlarged pulmonary trunk and right pulmonary artery, increased pulmonary vasculature, and a patchy infiltration at left upper lung zone. ECG: normal sinus rhythm with evidence of right ventricular hypertrophy and right axis deviation.
Blood test: mild normocytic anaemia (Hb 11.4 g/dL, Hct 38.0 %, MCV 81.7 fL), thrombocytopenia with platelet count 88000 /mm3, and normal white blood cell series.
🔸Echocardiogram is below.👇
🔻What would you do next?
A. Emergency baby delivery
B. Right heart catheterization
C. Counseling with multidisciplinary team
D. Bedrest and therapy until delivery
📄📄در #نظرسنجی شرکت کنید 📄📄
📌#پاسخ فردا در همین کانال 👇
🖥 https://bit.ly/2MbSCQz
✨ Join Us✨
📲 @IRathero 💫
Iranian Society of Atherosclearosis
Question of the week
What would you do next?
📚📖#آموزشی : 📚📖
🚩#Quiz Of The Week
* #ESCardioEd challenge by Marco Spartera and team, University of Oxford, England.
✳️ A 58-year-old female with worsening effort dyspnoea and fatigue. Clinical examination was notable for jugular venous distension and pitting oedema of the feet and ankles.
Past medical history: Persistent AF 2 years previously and heart failure symptoms, two catheter ablation procedures for AF, including pulmonary vein isolation and roof and mitral isthmus lines. However, symptoms of effort dyspnoea and fatigue had progressed despite maintenance of sinus rhythm.
Family history: dilated cardiomyopathy in the patient’s mother, but further details were not available.
Therapy : Warfarin, Bisoprolol 10 mg od, Ramipril 5 mg od, Spironolactone 37.5 mg od, Furosemide 20 mg od.
ECG: sinus rhythm with no evidence of ischaemia.
TTE: mild left ventricular (LV) dilation, with preserved LV systolic function and normal wall thickness, grade II diastolic dysfunction, mild right ventricle dilatation with preserved systolic function, sPAP 60mmHg. Both atria were moderate-severely dilated.
NT-proBNP: 1967 pg/mL. A 28 gene panel for DCM was negative.
At this stage, despite extensive investigations, no definite aetiology of heart failure was found. CMR is below.👇
The patient’s clinical condition slowly worsened with orthopnoea and NYHA class III heart failure requiring a brief hospital admission for intravenous diuretics. This culminated in a cardiac arrest whilst the patient was driving to attend an outpatient appointment, resulting in a serious motor vehicle accident on the motorway. Brought in hospital by ambulance, patient fully recovered neurologically. Repeat echocardiography revealed a dilated right ventricle with severe pulmonary hypertension. A further cardiac magnetic resonance scan is showed below. No change in the pattern of LGE was observed.
🔻What investigation is most appropriate?
A. Coronary angiography
B. Ventilation-perfusion scintigraphy
C. Right Heart catheterization
D. 7-day Holter ECG
E. Endomyocardial biopsy
📄📄در #نظرسنجی شرکت کنید 📄📄
📌#پاسخ فردا در همین کانال 👇
🖥 https://bit.ly/3fqkvkx
✨ Join Us✨
📲 @IRathero 💫
🚩#Quiz Of The Week
* #ESCardioEd challenge by Marco Spartera and team, University of Oxford, England.
✳️ A 58-year-old female with worsening effort dyspnoea and fatigue. Clinical examination was notable for jugular venous distension and pitting oedema of the feet and ankles.
Past medical history: Persistent AF 2 years previously and heart failure symptoms, two catheter ablation procedures for AF, including pulmonary vein isolation and roof and mitral isthmus lines. However, symptoms of effort dyspnoea and fatigue had progressed despite maintenance of sinus rhythm.
Family history: dilated cardiomyopathy in the patient’s mother, but further details were not available.
Therapy : Warfarin, Bisoprolol 10 mg od, Ramipril 5 mg od, Spironolactone 37.5 mg od, Furosemide 20 mg od.
ECG: sinus rhythm with no evidence of ischaemia.
TTE: mild left ventricular (LV) dilation, with preserved LV systolic function and normal wall thickness, grade II diastolic dysfunction, mild right ventricle dilatation with preserved systolic function, sPAP 60mmHg. Both atria were moderate-severely dilated.
NT-proBNP: 1967 pg/mL. A 28 gene panel for DCM was negative.
At this stage, despite extensive investigations, no definite aetiology of heart failure was found. CMR is below.👇
The patient’s clinical condition slowly worsened with orthopnoea and NYHA class III heart failure requiring a brief hospital admission for intravenous diuretics. This culminated in a cardiac arrest whilst the patient was driving to attend an outpatient appointment, resulting in a serious motor vehicle accident on the motorway. Brought in hospital by ambulance, patient fully recovered neurologically. Repeat echocardiography revealed a dilated right ventricle with severe pulmonary hypertension. A further cardiac magnetic resonance scan is showed below. No change in the pattern of LGE was observed.
🔻What investigation is most appropriate?
A. Coronary angiography
B. Ventilation-perfusion scintigraphy
C. Right Heart catheterization
D. 7-day Holter ECG
E. Endomyocardial biopsy
📄📄در #نظرسنجی شرکت کنید 📄📄
📌#پاسخ فردا در همین کانال 👇
🖥 https://bit.ly/3fqkvkx
✨ Join Us✨
📲 @IRathero 💫
Iranian Society of Atherosclearosis
Question of the week
What investigation is most appropriate?
Forwarded from اتچ بات
📚📖#آموزشی : 📚📖
🚩#Quiz Of The Week
* #ESCardioEd challenge by Dr Umberto Barbero and team, Santissima Annunziata Hospital of Savigliano, ASLCN1, Savigliano, Italy.
✳️ After two days from an episode of acute pain in the left shoulder, which radiated posteriorly and lasted one hour then slowly vanished, a 74 years-old lady reported the episode to her General Practioner who asked for an ECG (figure below). She was referred to the emergency department where echocardiography showed severe impairment of left ventricular function with mid-apical akinesia and hyperkinetic basal segments, with a giant thrombus in the apex (video in the comments section). She was taken in our Intensive Cardiac Unit and she was treated with diuretics, heparin, aspirin, beta-blockers and ticagrelor and prepared for coronary angiography.
What's the diagnosis?
1. Late anterior #STEMI presentation, by then asymptomatic
2. #Brugada Syndrome
3. #Takotsubo syndrome
4. Dilated #Cardiomyopathy with embolizing left ventricular apical thrombus
✅ #مشاهده_تصویر 👇
📄📄در #نظرسنجی شرکت کنید 📄📄
📌#پاسخ فردا در همین کانال 👇
🖥 air.ir/ZHm3R
✨ Join Us✨
📲 @IRathero 💫
🚩#Quiz Of The Week
* #ESCardioEd challenge by Dr Umberto Barbero and team, Santissima Annunziata Hospital of Savigliano, ASLCN1, Savigliano, Italy.
✳️ After two days from an episode of acute pain in the left shoulder, which radiated posteriorly and lasted one hour then slowly vanished, a 74 years-old lady reported the episode to her General Practioner who asked for an ECG (figure below). She was referred to the emergency department where echocardiography showed severe impairment of left ventricular function with mid-apical akinesia and hyperkinetic basal segments, with a giant thrombus in the apex (video in the comments section). She was taken in our Intensive Cardiac Unit and she was treated with diuretics, heparin, aspirin, beta-blockers and ticagrelor and prepared for coronary angiography.
What's the diagnosis?
1. Late anterior #STEMI presentation, by then asymptomatic
2. #Brugada Syndrome
3. #Takotsubo syndrome
4. Dilated #Cardiomyopathy with embolizing left ventricular apical thrombus
✅ #مشاهده_تصویر 👇
📄📄در #نظرسنجی شرکت کنید 📄📄
📌#پاسخ فردا در همین کانال 👇
🖥 air.ir/ZHm3R
✨ Join Us✨
📲 @IRathero 💫
Telegram
attach 📎
Forwarded from اتچ بات
📚📖#آموزشی : 📚📖
🚩#Quiz Of The Week
* #ESCardioEd challenge by Dr Francesco Petracca and team, Cardiocentro Ticino Institute, Lugano, Switzerland.
✳️ A 44-year-old woman with history of drug addiction and cirrhosis related to chronic hepatitis C infection, presented to the out-patient clinic with severe right-sided heart failure. She underwent partial tricuspid valve resection and De Vega annuloplasty in 2001 for infective endocarditis and in 2009 a tricuspid #valve_replacement with a Carpentier-Edwards Perimount Magna 31 mm valve, for symptomatic severe tricuspid regurgitation recurrence.
Transthoracic #echocardiography on admission showed degeneration of the bioprosthetic valve.
The heart team decided to proceed with a trans-jugular implantation of a new valve in view of the patient’s overall frailty and significant comorbid conditions.
The preoperative computed tomography showed total occlusion of the internal jugular vein up to the subclavian vein confluence (figure 2 below), making this vascular access route unsuitable.
What #vascular access would you choose?
✅ #مشاهده_تصویر 👇
📌#پاسخ فردا در همین کانال 👇
🖥 air.ir/ZHmbR
🖥 air.ir/ZHmcR
✨ Join Us✨
📲 @IRathero 💫
🚩#Quiz Of The Week
* #ESCardioEd challenge by Dr Francesco Petracca and team, Cardiocentro Ticino Institute, Lugano, Switzerland.
✳️ A 44-year-old woman with history of drug addiction and cirrhosis related to chronic hepatitis C infection, presented to the out-patient clinic with severe right-sided heart failure. She underwent partial tricuspid valve resection and De Vega annuloplasty in 2001 for infective endocarditis and in 2009 a tricuspid #valve_replacement with a Carpentier-Edwards Perimount Magna 31 mm valve, for symptomatic severe tricuspid regurgitation recurrence.
Transthoracic #echocardiography on admission showed degeneration of the bioprosthetic valve.
The heart team decided to proceed with a trans-jugular implantation of a new valve in view of the patient’s overall frailty and significant comorbid conditions.
The preoperative computed tomography showed total occlusion of the internal jugular vein up to the subclavian vein confluence (figure 2 below), making this vascular access route unsuitable.
What #vascular access would you choose?
✅ #مشاهده_تصویر 👇
📌#پاسخ فردا در همین کانال 👇
🖥 air.ir/ZHmbR
🖥 air.ir/ZHmcR
✨ Join Us✨
📲 @IRathero 💫
Telegram
attach 📎