Loading ...
Sorry, an error occurred while loading the content.

fwd:Subaortic obstruction in acute MI

Expand Messages
  • Shindler, Daniel
    From: Wanderley To: Sent: Thursday, August 22, 2002 7:50 PM Subject: Re: [echocardiography]
    Message 1 of 11 , Sep 9, 2002
    • 0 Attachment
      From: "Wanderley" <wqp@...>
      To: <echocardiography@yahoogroups.com>
      Sent: Thursday, August 22, 2002 7:50 PM
      Subject: Re: [echocardiography] fwd:Subaortic obstruction in acute MI

      > I saw this case (in attach) in the last week.
      > 84 Yr old lady.
      > Two months before this Echo, has begun fatigue.
      > No cardiologyc history. No HP.
      >
      > Thanks
      >
      > Wanderley Q. Pereira MD
      > ECOR Rio de Janeiro Brazil
      ----------------------------------------

      > ----- Original Message -----
      > From: "Daniel Shindler" <shindler@...>
      > To: <echocardiography@yahoogroups.com>
      > Sent: Thursday, August 22, 2002 5:05 PM
      > Subject: [echocardiography] fwd:Subaortic obstruction in acute MI
      >
      >
      > > Subject: Subaortic obstruction in acute MI
      > > Date: Sun, 18 Aug 2002 18:00:01 +0530
      > > From: "Dr.D.Kannan" <echolab@...>
      > >
      > > To our Group
      > >
      > > 55 Yr old lady admitted with acute anterior wall MI
      > > was thrombolysed & she had successful reperfusion.Two
      > > days later patient had reinfarction with hypotension
      > > & pulmonary oedema & new systolic murmur was noted .
      > > Patient devloped Ventricular tachycardia & collapsed.
      > > Cardioverted & intubated BP was not recordable .Pupil
      > > was dilated & fixed without any spontaneous
      > > respiration Emergency transthorocic echo was done.
      > > Patient was on dopamine & respiration was maintained with
      > > endotracheal tube. BP was not recordable .Echo revealed
      > > Apical 4C view : Dyskinetic lower 1/3 of IVS , apical
      > > & adjacent free wall segment & hyperkinetic basal IVS
      > > bulging into LVOT with increased flow velocity across
      > > LVOT 3 m/sec.with a flow velocity of 80 cm/sec in Aorta
      > > There was no mitral regurg. Dopamine drip was stopped
      > > & IV fluids were infused.Patient had Vent.Tach. four
      > > times.In 10 MNTS LVOT flow velocity camedown to 1 m/sec.
      > > BP picked up.Patient regained spontaneous respiration
      > > after 4 hrs & recovered without any neurologic deficit
      > > Emergency bedside echo could not be recorded
      > > This pictures were taken after 2 days showing turbulance
      > > in LVOT with LVOT velocity of 1.8 m/sec
      > >
      > > We have started graded ambulation now.
      > >
      > > How common is LVOT Obstruction in acute ischemia ?
      > > I like to know about your experiences ?
      > >
      > > Kannan
    • krishnam raju
      this dynamic lvot obstruction is due to dopamine you have used. not related to ischaemia or MI. Prof. P Krishnam Raju, MD., DM Prof & Head of the Dept. of
      Message 2 of 11 , Sep 11, 2002
      • 0 Attachment

        this dynamic lvot obstruction is due to dopamine you have used. not related to ischaemia or      MI.




        Prof. P Krishnam Raju, MD., DM
        Prof & Head of the Dept. of Cardiology
        Osmania Genereal Hospital / Osmania Medical College
        Afzalgunj, Hyderabad - 500 012
        India.
        Contact No.s :
        0091 - 40 - 460 0146 Ext: 613 (Office)
        0091 - 40 - 780 5271(Res)
        0091 - 40 - 780 3161(Res)
        0091 - 40 - 320 3565(Fax)
        0091 - 40 - 461 9465(Fax)
        >From: "Shindler, Daniel"
        >Reply-To: echocardiography@yahoogroups.com
        >To: "echocardiography@yahoogroups.com"
        >Subject: [echocardiography] fwd:Subaortic obstruction in acute MI
        >Date: Mon, 9 Sep 2002 10:19:30 -0400
        >
        >From: "Wanderley"
        >To:
        >Sent: Thursday, August 22, 2002 7:50 PM
        >Subject: Re: [echocardiography] fwd:Subaortic obstruction in acute MI
        >
        > > I saw this case (in attach) in the last week.
        > > 84 Yr old lady.
        > > Two months before this Echo, has begun fatigue.
        > > No cardiologyc history. No HP.
        > >
        > > Thanks
        > >
        > > Wanderley Q. Pereira MD
        > > ECOR Rio de Janeiro Brazil
        >----------------------------------------
        >
        > > ----- Original Message -----
        > > From: "Daniel Shindler"
        > > To:
        > > Sent: Thursday, August 22, 2002 5:05 PM
        > > Subject: [echocardiography] fwd:Subaortic obstruction in acute MI
        > >
        > >
        > > > Subject: Subaortic obstruction in acute MI
        > > > Date: Sun, 18 Aug 2002 18:00:01 +0530
        > > > From: "Dr.D.Kannan"
        > > >
        > > > To our Group
        > > >
        > > > 55 Yr old lady admitted with acute anterior wall MI
        > > > was thrombolysed & she had successful reperfusion.Two
        > > > days later patient had reinfarction with hypotension
        > > > & pulmonary oedema & new systolic murmur was noted .
        > > > Patient devloped Ventricular tachycardia & collapsed.
        > > > Cardioverted & intubated BP was not recordable .Pupil
        > > > was dilated & fixed without any spontaneous
        > > > respiration Emergency transthorocic echo was done.
        > > > Patient was on dopamine & respiration was maintained with
        > > > endotracheal tube. BP was not recordable .Echo revealed
        > > > Apical 4C view : Dyskinetic lower 1/3 of IVS , apical
        > > > & adjacent free wall segment & hyperkinetic basal IVS
        > > > bulging into LVOT with increased flow velocity across
        > > > LVOT 3 m/sec.with a flow velocity of 80 cm/sec in Aorta
        > > > There was no mitral regurg. Dopamine drip was stopped
        > > > & IV fluids were infused.Patient had Vent.Tach. four
        > > > times.In 10 MNTS LVOT flow velocity camedown to 1 m/sec.
        > > > BP picked up.Patient regained spontaneous respiration
        > > > after 4 hrs & recovered without any neurologic deficit
        > > > Emergency bedside echo could not be recorded
        > > > This pictures were taken after 2 days showing turbulance
        > > > in LVOT with LVOT velocity of 1.8 m/sec
        > > >
        > > > We have started graded ambulation now.
        > > >
        > > > How common is LVOT Obstruction in acute ischemia ?
        > > > I like to know about your experiences ?
        > > >
        > > > Kannan
        >
        >
        >
        >
        >
        >
        >
        >
        >
        >Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
        >
        ><< wqp2.GIF >>
        ><< Wqp1.GIF >>


        Send and receive Hotmail on your mobile device: Click Here
      • Wanderley
        Dr. P K Raju In our case I didn`t use inotropic agents. The exam was get at rest. The patients came using Captopril + furosemide Thanks Wanderley Quarte
        Message 3 of 11 , Sep 11, 2002
        • 0 Attachment
          Dr. P K  Raju
          In our case I didn`t use inotropic agents.
          The exam was get at rest.
          The patients came  using Captopril + furosemide
           
          Thanks
           
          Wanderley Quarte Pereira
           
          Rio de janeiro       Brazil
          ----- Original Message -----
          Sent: Wednesday, September 11, 2002 4:25 AM
          Subject: Re: [echocardiography] fwd:Subaortic obstruction in acute MI

          this dynamic lvot obstruction is due to dopamine you have used. not related to ischaemia or      MI.




          Prof. P Krishnam Raju, MD., DM
          Prof & Head of the Dept. of Cardiology
          Osmania Genereal Hospital / Osmania Medical College
          Afzalgunj, Hyderabad - 500 012
          India.
          Contact No.s :
          0091 - 40 - 460 0146 Ext: 613 (Office)
          0091 - 40 - 780 5271(Res)
          0091 - 40 - 780 3161(Res)
          0091 - 40 - 320 3565(Fax)
          0091 - 40 - 461 9465(Fax)
          >From: "Shindler, Daniel"
          >Reply-To: echocardiography@yahoogroups.com
          >To: "echocardiography@yahoogroups.com"
          >Subject: [echocardiography] fwd:Subaortic obstruction in acute MI
          >Date: Mon, 9 Sep 2002 10:19:30 -0400
          >
          >From: "Wanderley"
          >To:
          >Sent: Thursday, August 22, 2002 7:50 PM
          >Subject: Re: [echocardiography] fwd:Subaortic obstruction in acute MI
          >
          > > I saw this case (in attach) in the last week.
          > > 84 Yr old lady.
          > > Two months before this Echo, has begun fatigue.
          > > No cardiologyc history. No HP.
          > >
          > > Thanks
          > >
          > > Wanderley Q. Pereira MD
          > > ECOR Rio de Janeiro Brazil
          >----------------------------------------
          >
          > > ----- Original Message -----
          > > From: "Daniel Shindler"
          > > To:
          > > Sent: Thursday, August 22, 2002 5:05 PM
          > > Subject: [echocardiography] fwd:Subaortic obstruction in acute MI
          > >
          > >
          > > > Subject: Subaortic obstruction in acute MI
          > > > Date: Sun, 18 Aug 2002 18:00:01 +0530
          > > > From: "Dr.D.Kannan"
          > > >
          > > > To our Group
          > > >
          > > > 55 Yr old lady admitted with acute anterior wall MI
          > > > was thrombolysed & she had successful reperfusion.Two
          > > > days later patient had reinfarction with hypotension
          > > > & pulmonary oedema & new systolic murmur was noted .
          > > > Patient devloped Ventricular tachycardia & collapsed.
          > > > Cardioverted & intubated BP was not recordable .Pupil
          > > > was dilated & fixed without any spontaneous
          > > > respiration Emergency transthorocic echo was done.
          > > > Patient was on dopamine & respiration was maintained with
          > > > endotracheal tube. BP was not recordable .Echo revealed
          > > > Apical 4C view : Dyskinetic lower 1/3 of IVS , apical
          > > > & adjacent free wall segment & hyperkinetic basal IVS
          > > > bulging into LVOT with increased flow velocity across
          > > > LVOT 3 m/sec.with a flow velocity of 80 cm/sec in Aorta
          > > > There was no mitral regurg. Dopamine drip was stopped
          > > > & IV fluids were infused.Patient had Vent.Tach. four
          > > > times.In 10 MNTS LVOT flow velocity camedown to 1 m/sec.
          > > > BP picked up.Patient regained spontaneous respiration
          > > > after 4 hrs & recovered without any neurologic deficit
          > > > Emergency bedside echo could not be recorded
          > > > This pictures were taken after 2 days showing turbulance
          > > > in LVOT with LVOT velocity of 1.8 m/sec
          > > >
          > > > We have started graded ambulation now.
          > > >
          > > > How common is LVOT Obstruction in acute ischemia ?
          > > > I like to know about your experiences ?
          > > >
          > > > Kannan
          >
          >
          >
          >
          >
          >
          >
          >
          >
          >Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
          >
          ><< wqp2.GIF >>
          ><< Wqp1.GIF >>


          Send and receive Hotmail on your mobile device: Click Here

          Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.
        • Bill Phillips
          To the echo group: I am searching for TEE Probes to purchase, working or not. I an interested in purchasing any omni-plane/ multi-plane HP, Acuson or ATL TEE
          Message 4 of 11 , Sep 11, 2002
          • 0 Attachment

            To the echo group:

            I am searching for TEE Probes to purchase, working or not.

            I an interested in purchasing any omni-plane/ multi-plane HP, Acuson or ATL TEE probe that you would like to liquidate.

             

            Thanks,

            Bill

            phillipsbill@...

             

             

             

             

          • Mark Harry
            Krishnam, This is an interesting color Doppler and PW Doppler study. It is a bit difficult to come up with this patient s clinical picture from just two
            Message 5 of 11 , Sep 11, 2002
            • 0 Attachment
              Krishnam,

              This is an interesting color Doppler and PW Doppler study. It is a bit
              difficult to come up with this patient's clinical picture from just two
              pictures. But here is what I think.

              These pictures demonstrate a mid cavity obstruction not an LVOT obstruction.
              What is most interesting about this case is the color Doppler and PW Doppler
              flow away from the apex at the mid cavity level in diastole. The first
              picture is not very clear but it looks like the apex is dilated and
              aneurysmal (? apical infarct). The mid segments of the septal and lateral
              wall look very thick given this is a diastolic frame (mitral valve looks to
              be open). This mid cavity narrowing essentially creates two seperate
              chambers within the LV. The systolic PW Doppler signal is the classic
              systolic flow pattern seen in patient's with mid cavity obstruction. The
              early to mid distolic PW Doppler signal indicates that during diastole the
              pressure in this dilated aneurysmal apex is higher then the upper portion of
              the LV (flow away from the transducer). It is not until late diastole (just
              before the P wave) that there is any flow into the apical cavity (towards
              the transducer). The key to this hemodynamic presentation is a large apical
              infarct in a patient with mid cavity obstruction. The degree of mid cavity
              obstruction may or may not be enhanced by volume depletion. It is not
              possible to say from the information presented.

              Mark Harry
              Technical Director Echocardiography
              Iowa Heart Center

              > ----------
              > From: krishnam raju
              > Reply To: echocardiography@yahoogroups.com
              > Sent: Wednesday, September 11, 2002 2:25 AM
              > To: echocardiography@yahoogroups.com
              > Subject: Re: [echocardiography] fwd:Subaortic obstruction in acute MI
              >
              > this dynamic lvot obstruction is due to dopamine you have used. not
              > related to ischaemia or MI.
              >
              >
              >
              >
              >
              >
              > Prof. P Krishnam Raju, MD., DM
              > Prof & Head of the Dept. of Cardiology
              > Osmania Genereal Hospital / Osmania Medical College
              > Afzalgunj, Hyderabad - 500 012
              > India.
              > Contact No.s :
              > 0091 - 40 - 460 0146 Ext: 613 (Office)
              > 0091 - 40 - 780 5271(Res)
              > 0091 - 40 - 780 3161(Res)
              > 0091 - 40 - 320 3565(Fax)
              > 0091 - 40 - 461 9465(Fax)
              > >From: "Shindler, Daniel"
              > >Reply-To: echocardiography@yahoogroups.com
              > >To: "echocardiography@yahoogroups.com"
              > >Subject: [echocardiography] fwd:Subaortic obstruction in acute MI
              > >Date: Mon, 9 Sep 2002 10:19:30 -0400
              > >
              > >From: "Wanderley"
              > >To:
              > >Sent: Thursday, August 22, 2002 7:50 PM
              > >Subject: Re: [echocardiography] fwd:Subaortic obstruction in acute MI
              > >
              > > > I saw this case (in attach) in the last week.
              > > > 84 Yr old lady.
              > > > Two months before this Echo, has begun fatigue.
              > > > No cardiologyc history. No HP.
              > > >
              > > > Thanks
              > > >
              > > > Wanderley Q. Pereira MD
              > > > ECOR Rio de Janeiro Brazil
              > >----------------------------------------
              > >
              > > > ----- Original Message -----
              > > > From: "Daniel Shindler"
              > > > To:
              > > > Sent: Thursday, August 22, 2002 5:05 PM
              > > > Subject: [echocardiography] fwd:Subaortic obstruction in acute MI
              > > >
              > > >
              > > > > Subject: Subaortic obstruction in acute MI
              > > > > Date: Sun, 18 Aug 2002 18:00:01 +0530
              > > > > From: "Dr.D.Kannan"
              > > > >
              > > > > To our Group
              > > > >
              > > > > 55 Yr old lady admitted with acute anterior wall MI
              > > > > was thrombolysed & she had successful reperfusion.Two
              > > > > days later patient had reinfarction with hypotension
              > > > > & pulmonary oedema & new systolic murmur was noted .
              > > > > Patient devloped Ventricular tachycardia & collapsed.
              > > > > Cardioverted & intubated BP was not recordable .Pupil
              > > > > was dilated & fixed without any spontaneous
              > > > > respiration Emergency transthorocic echo was done.
              > > > > Patient was on dopamine & respiration was maintained with
              > > > > endotracheal tube. BP was not recordable .Echo revealed
              > > > > Apical 4C view : Dyskinetic lower 1/3 of IVS , apical
              > > > > & adjacent free wall segment & hyperkinetic basal IVS
              > > > > bulging into LVOT with increased flow velocity across
              > > > > LVOT 3 m/sec.with a flow velocity of 80 cm/sec in Aorta
              > > > > There was no mitral regurg. Dopamine drip was stopped
              > > > > & IV fluids were infused.Patient had Vent.Tach. four
              > > > > times.In 10 MNTS LVOT flow velocity camedown to 1 m/sec.
              > > > > BP picked up.Patient regained spontaneous respiration
              > > > > after 4 hrs & recovered without any neurologic deficit
              > > > > Emergency bedside echo could not be recorded
              > > > > This pictures were taken after 2 days showing turbulance
              > > > > in LVOT with LVOT velocity of 1.8 m/sec
              > > > >
              > > > > We have started graded ambulation now.
              > > > >
              > > > > How common is LVOT Obstruction in acute ischemia ?
              > > > > I like to know about your experiences ?
              > > > >
              > > > > Kannan
              > >
              > >
              > >
              > >
              > >
              > >
              > >
              > >
              > >
              > >Your use of Yahoo! Groups is subject to http://docs.yahoo.com/info/terms/
              >
              > >
              > ><< wqp2.GIF >>
              > ><< Wqp1.GIF >>
              >
              > _____
              >
              > Send and receive Hotmail on your mobile device: Click Here
              >
              > Your use of Yahoo! Groups is subject to the Yahoo! Terms of Service.
              >
            • Dr. George Thomas
              Dear Dr.Wanderley: Probably Dr.Krishnam Raju (message 3623) was replying to the message by Dr.Kannan (3597). I totally agree with Dr. Raju in that case. Dr.
              Message 6 of 11 , Sep 13, 2002
              • 0 Attachment
                Dear Dr.Wanderley:

                Probably Dr.Krishnam Raju (message 3623) was replying to the message
                by Dr.Kannan (3597). I totally agree with Dr. Raju in that case.

                Dr. Wanderley's case is interesting (3603 and 3624).

                Of course, excuse me for being an armchair echocardiologist! From the
                limited data available here are a few comments:

                You say the patient is an 84 year old female with fatigue. She was on
                captopril and frusemide. From your images I feel it is probably
                NORMAL for her age. "Carinate septum" is a common finding in
                the
                elderly. Here, there is a bulge in the septum which appears to cause
                obstruction. However carefully note the Doppler spectral display. The
                velocity is just under 2m/sec and the pattern is that of LV mid-
                cavity with a "J" wave. The turbulent flow is exaggerated due
                to the
                color settings. This is of no hemodynamic consequence.

                Would you try stopping the frusemide? This could be the cause of
                fatigue.

                Dr. George Thomas
                Kochi, India



                --- In echocardiography@y..., "Shindler, Daniel"
                <daniel.shindler@r...> wrote:
                > From: "Wanderley" <wqp@e...>
                > To: <echocardiography@y...>
                > Sent: Thursday, August 22, 2002 7:50 PM
                > Subject: Re: [echocardiography] fwd:Subaortic obstruction in acute
                MI
                >
                > > I saw this case (in attach) in the last week.
                > > 84 Yr old lady.
                > > Two months before this Echo, has begun fatigue.
                > > No cardiologyc history. No HP.
                > >
                > > Thanks
                > >
                > > Wanderley Q. Pereira MD
                > > ECOR Rio de Janeiro Brazil
              • JLCJR55@aol.com
                Look for thrombus, any TIA sequela post?
                Message 7 of 11 , Sep 28, 2002
                • 0 Attachment
                  Look for thrombus, any TIA sequela post?
                Your message has been successfully submitted and would be delivered to recipients shortly.