超声心动在日常心脏病学实践中的应用

1、STAT EchocardiographySTAT Echocardiography Guidelines for STAT Echo Indications for Examples (1) Examples (2) 70 yo F, found to be unresponsible in the nursing home with BP of 82 / 40 mmHg and a HR of 121 bpm Inadequate Preload ! Inadequate Preload 90 yo m, severe SSCP with radiation to the left arm

2、 and diapherasis. EKG sinus tacky with non-sp ST-T changes. Labs pending 51 yo F, severe CP after being caught in the mall for stealing. BP 140/88, HR 92. Borderline ST elevation in I, AVL and V4-6. Borderline high cardiac markers. Takotsubo Cardiomyopathy ! Takotsubo Cardiomyopathy 51 yo M with sev

3、ere SOB. PMH with lung cancer treated by chemo/radiation 1 yr ago. BP 78/40, HR 112. Tamponade ! The Subcostal Views RA / RV Collapse PLEURAL vs. PERICARDIAL EFFUSION Doppler Echoc Features of Tamponade 79 yo M, acute CP with SOB for 2 hrs. PE and CXR showed pulmonary edema. A 2-3/6 systolic murmur

4、the apex. There were ST elevation in the inferior leads. Papillary muscle rupture ! Papillary Muscle Rupture 71 yo F, SOB for 6 hrs. BP 78/40, HR 98, No murmur. 58 yo F, CP and SOB for 10 days. BP 60/40, HR 130. CXR cardiomegaly. EKG sinus tachy with LBBB. No murmur 93 yo F, S/P STEMI-ant. & PCI wit

5、h stent to LAD. Hypotension with BP 78/48, Tachycardia with HR of 110. On Dob/Dop drip V = 441 cm/s PG = 77.8 mmHg 93 yo F, SSCP with SOB for 1 day. R/I SIEMI-lateral. Abnormal LV gram. BP 87/50, HR 98, No murmur. PE Thrombi from DVT to RV and LA 77 yo F, CP with SOB for 2 or 3 days. Hx of HTN, hype

6、rlipidemia and DM. BP 78/40, HR 98, No murmur. Pericardial Complications of MI 85 yo F, transferred from nursing home with CP off and on for days. EKG was c/w ant STEMI. A heart murmur 3-4/6 at the apex. CXR: clear lungs Case 10 59 yo M, s/p acute IMI and PCI with stents x 2 in the mid-RCA. Cont. hy

7、potension with BP 75-80/40-50. Free Wall Rupture Acute pulmonary embolism McConnells sign RV-MI vs. PE 82 yo M s/p STEMI inferior and PCI with 2 stents to RCA. Hypotension and bradycardia. RV Infarction! 51 yo F, acute SOB. CXR normal, EKG sinus tachy only. BP 80/36, HR 130. Mild systolic murmur ULS

8、B 78 yo F, 3 days S/P MV repair for MVP with a MV ring. Hypotension and new A fib with RVR MV Ring Dehiscence! 18 yo M admitted to Trauma Unit after a Blunt chest injury in an automobile crash. Found a heart murmur of 2/6 along the RSB and slightly elevated Trop T TV Papillary Rupture (partial)! 78 yo F, fou