Ginghina C. Mic tratat de cardiologie. Romania: Editura Academiei Romane; Greyson CR. The right ventricle and pulmonary circulation: basic concepts. the Romanian Journal of Cardiology and I are looking forward to your comments and suggestions! Kindest regards, Professor Carmen Ginghina Editor in chief. Eduard Apetrei. “CC Iliescu” Department of Cardiology – A short history. Cardiologie, cazuri comentate si Ilustrate, Eduard Apetrei, Carmen Ginghina.

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Ed Academiei Romane ; Echocardiography in the assessment of right heart function. Diagnosing Pulmonary Embolism Chest. However, this has low specificity when an anterior left ventricular myocardial infarction is not excluded. It is frequently recognized in cardiolohie literature as well as in daily clinical ginghiba that the right ventricular myocardial infarction RVMI and pulmonary embolism PE are two of the most challenging clinical pictures to differentiate in cardiology and the treatment, often chosen upon a mixture of clinical suspicion criteria subsequently confirmed by other diagnostic methods.

Sometimes arrhythmias are also present extra systoles, atrial fibrillation. Massive pulmonary embolism with ST elevation in leads V1 —V3 and successful thrombolysis with tenecteplase. Continuous Doppler echocardiography at the tricuspid valve: Clinical diagnosis alternative diagnosis less likely than pulmonary embolism. Clinically, RVMI is frequently associated with inferior or posterior myocardial czrdiologie and presents with:. Diagnostic value of D—dimer measurement in patients referred to the emergency department with suspected myocardial ischemia.

Carsiologie investigations Coronary arteriography is not routinely used in diagnosing, but it is more frequently used to identify the coronary lesions more precisely, with the precise scope of performing primary angioplasty.

A manifestation of occult right ventricular infarction. Author information Article notes Copyright and License information Disclaimer.

The data can be classified into three categories:. Hipertensiunea pulmonara in practica de cardiologie.

Differential diagnosis is often difficult due to similar clinical picture, unspecific electrocardiographic changes and unspecific biological markers. Electrocardiography in a case of pulmonary embolism: Inferior vena cardologie dilatation without respiratory variations is also present. Coronary arteriography is not routinely used in diagnosing, but it is more frequently used to identify the coronary lesions more precisely, with the precise scope of performing primary angioplasty.


In extensive RVMI, ventricular filling and ejection flows are very slow and they last for almost the entire cardiac cycle. Right ventricle dilatation may be present in those cases.

GINGHINA mic tratat de cardiologie.pdf

Defects in the motion of the interventricular septum can be present during systole paradoxical movement as well as in diastole suggesting high right ventricle pressures with inverted trans—septal pressure gradient.

Because of the challenges that the differential diagnosis poses, based on clinical assessment, performing an echocardiogram is very important.

Table 4 ECG diagnosis criteria for pulmonary embolism modified from Chou [ 21 ]. Wells Score caddiologie 2 ]. This technique, however, cannot differentiate between acute necrosis and old myocardial infarction and, can also have false negative results in those cases with small necrosis.

Because it is an invasive method, it is not routinely used; being performed only in those cases where the diagnostic is not confirmed and all the other methods cannot bring sufficient information, or where a therapeutic approach such as an endovascular intervention is considered.

In patients with clinically suspected PE, the initial clinical evaluation is concomitant with the risk stratification and clinical probability assessment. The non—invasive diagnosis of right ventricular infarction. Magnetic resonance imaging can rapidly identify within 1 hour those changes present vinghina an acute myocardial infarction, and, it is the only method that can really differentiate between subendocardial and the transmural infarction.

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This method is particularly useful in RVMI cases. The specific signs identified in patients with PE are not as specific and they are useful to confirm PE only by associating them with the clinical context Table 1. Clinically, RVMI is frequently associated ginhgina inferior or posterior myocardial infarction and presents with: In RVMI, the arterial blood gases can be normal but in massive infarction secondary hypoxemia, they can be present due to low cardiac output.

Figure 2 [ 21 — 24 ]. Nuclear imaging Radionuclide ventriculography is useful in investigating myocardial infarction as it allows the evaluation of ventricular volumes, segmental wall motion and ejection fraction. Regional right ventricular dysfunction in acute pulmonary embolism and right ventricular infarction.

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The profile changes from protomezosystolic to telesystolic and even protodiastolic postsystolic shortening [ 42 — 43 ]. Q—wave and non—q—wave myocardial infarctions through the eyes of cardiac magnetic resonance imaging. Other diagnostic methods used in the investigation of clinically suspected PE Doppler venous ultrasound, Contrast venography; Impedance pletismography are useful in evaluating patients with clinically suspected PE, as it can show thrombi in the lower limbs venous system or in other territories.


Table 1 Clinical symptoms and signs described in pulmonary embolism [ 2 ]. Pulmonary perfusion scintigraphy is useful in diagnosing PE. Doppler recording indicating tricuspid regurgitation, with an estimated RV-RA gradient of 37mmHg pulmonary embolism.

Inferior vena cava dilatation can be present and respiratory variations are usually lacking Figure 4Figure 5 [ 840 — 45 ]. In RVMI, there is an evident significant dilatation with motion abnormalities at the level of right ventricle free wall, especially in the apical area, with a reduced ejection fraction.

In the meanwhile, the CT scan is not so helpful in evaluating patients with myocardial infarction. Acquired right ventricular dysfunction.

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In RVMI, the systolic and early diastolic velocities, myocardial velocities for the free right ginghlna are decreased. An alveolo—arterial ratio higher than 15—20 is a more sensitive indicator for PE when compared to the oxygen pressure. Saunders — Elsevier; Echocardiography in the Management of Pulmonary Embolism. Frequently, right cardiac chambers are dilated in PE, the interventricular septum is flattened or even a leftward displacement is seen creating a D shape left ventricular aspect.

Cqrdiologie CO2 values can often be present due to hyperventilation associated with a mild degree of respiratory alkalosis.

A reliable marker for the right ventricular function is TAPSE tricuspid annular plane systolic excursion as it evaluates the longitudinal cardiac function. Tissue Doppler echocardiography can also demonstrate ventricular asynchrony by using septal and left ventricular free wall measurements. Chest CT scan using contrast substance is showing a filling gap at the level of left branch of pulmonary artery consistent with pulmonary thrombembolism.