#تابع Echocardiography in PE Diagnosis : RV dilation is f | "لعلي أفيدك" Clinical discussion

#تابع
Echocardiography in PE Diagnosis :

RV dilation is found in at least 25% of patients with PE Echocardiographic findings used to risk stratify patients with PE include RV dilation, an increased RV-LV diameter ratio, hypokinesia of the free RV wall,
increased velocity of the jet of tricuspid regurgitation, decreased tricuspid annulus plane systolic excursion, or combinations of the above.

A negative result cannot exclude PE.
On the other hand, signs of RV overload or dysfunction may also be found in the absence of acute PE and be due to concomitant cardiac or respiratory disease.

In suspected high-risk PE, the absence of echocardiographic signs of RV overload or dysfunction practically excludes PE as the cause of haemodynamic instability.
In the latter case, echocardiography may be of further help in the differential diagnosis of the cause of shock, by detecting pericardial tamponade, acute valvular dysfunction, severe global or regional LV dysfunction, aortic dissection, or hypovolaemia

Conversely, in a haemodynamically compromised patient with suspected PE, unequivocal signs of RV pressure overload and dysfunction justify emergency reperfusion treatment for PE if immediate CT angiography is not feasible.

Mobile right heart thrombi are detected by transthoracic or transoesophageal echocardiography (or by CT angiography) in less than 4% of unselected patients with PE

Increased RV wall thickness and/or tricuspid insufficiency jet velocity beyond values compatible with acute RV pressure overload.
In these cases, chronic pulmonary hypertension, and CTEPH in particular, should be included in the differential diagnosis.