Welcome to lecture 12 of our course, you now know how to perform a rapid echo study. In this second part of the course we'll be discussing the cartographic features of common cardiac disorders. This lecture topic is pulmonary embolism. pulmonary embolism is a very common pulmonary disorder with important cardiac consequences. A small embolism might have so little hemodynamic effects as to go unnoticed. However, acute occlusion of a sizable pulmonary artery branch can lead to RV failure.
The changes that occur in phoner embolism can be explained in this diagram. occlusion of a sizable branch of the pulmonary artery by thrombus will lead to increased pulmonary vascular resistance and pulmonary artery pressures. The back pressure leads to RV dilatation and increased RV pressure, leading to tricuspid regurgitation. This is an atypical for chamber view of a patient with pulmonary embolism. The echo cartographic changes and significant pulmonary embolism as follows First of all a dilated, hypo contractile RV. It's obvious just by looking at it.
If you didn't get that impression, it's okay. You'll acquire an eye for it as you practice, but if you've been systematic as we discussed in the previous lecture, and measured RV diameter and taxi, you will definitely find them abnormal. The second feature and this is a relatively specific feature in pulmonary embolism, although it doesn't always have to be there is called atypical spearing or McConnell sign. atypical spirit means that the RB hypo kinesia spares the apex so that typical contractility is normal. Another supportive feature for pulmonary embolism is finding significant tricuspid regurgitation and raised pulmonary artery pressures by Doppler. A pathognomonic.
Finding although rarely seen is the direct visualization of a thrombus in the pulmonary artery or right atrium, the pulmonary artery and In its bifurcation are best seen any pair of sternal short axes view a great vessel level. And this is an example of a thrombus visualized in the pulmonary artery. This is an example of a thrombus in the right atrium, or what we call thrombus in transit, in transit, meaning its way from the peripheral deep veins into the pulmonary circulation, but it got latched on to the tricuspid valve or the right atrium. This patient is a ticking time mom. Okay, this was a rather short lecture. In the next lecture, we'll be discussing pericardial effusion and temp fanat See you there.