Os trombos do VE

https://doi.org/10.1111/echo.14808

Current echocardiographic‐guided screening and management strategies for LVT in patients with recent anterior MI warrant to be re‐evaluated in light of the advances in technology which greatly improve the diagnostic accuracy of this approach as compared to CE‐CMR. However, this pathway relied on resolution on TTE as evidence of treatment effect requires prospective validation since many questions, such as the prognostic significance of LVT detected by CE‐CMR but not by contrast TTE, are still unanswered. In some cases, a LVT can be a marker of an increased thrombotic risk that persists at the long term, after the initial period of anticoagulation and even despite thrombus resolution by TTE. This knowledge could guide the selection of the optimal imaging modality for the screening of patients with recent anterior MI at high risk for LVT. Hopefully, this work might strengthen the role of echocardiography in the management of these patients.

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Outro dia, em visita da UCO, solicitaram RM para ver se o IAM anterior formou trombo no VE.

O que?

E o ecocardiograma transtorácico?

Exceto em janelas raras e ruins, o ecocardiograma é om melhor método para identificar possíveis trombos.

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Precisa saber acertar o transdutor e até usar o transdutor infantil.

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Mas é o exame.

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Pressão pulmonar ao ecocardiograma

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5454185/

A pulmonary regurgitation (PR) signal is obtained in the parasternal short axis view using colour Doppler. CW Doppler at a sweep speed of 100 mm/s is used to measure the peak PR velocity (Fig. 3). Peak pressure difference (measured by the Bernoulli equation) is then added to the RAP. This method has been validated against gold standard catheter-measurements [13][14].

Mean PAP can be approximated from the peak PR Doppler signal using the following formula: mPAP = 4(PRpeak velocity)2 + RAP.

Ou

mPAP = 2/3rd of PADP + 1/3rd of PASP.

Válvula ou Pulmão?

https://link.springer.com/article/10.1007/s11886-019-1240-7

Stress Echocardiography

The clinical indications for stress echocardiography (SE) in the context of PH-LHD are as follows: severe VHD without symptoms, non-severe VHD with symptoms, and symptomatic non-severe VHD with low flow . Heart rate normally increases two- to three-fold during exercise, contractility three- to four-fold, and systolic blood pressure by ≥ 50%, while systemic vascular resistance decreases. This often serves to reveal symptoms in patients previously considered asymptomatic or, for example, may demonstrate that mitral valve stenosis changes from moderate to severe with activity.

Therefore, SE may be a useful diagnostic tool in selected cases of suspected PH-LHD (pulmonary hypertension related to left heart disease ) leading to recommendations to treat the underlying VHD.