Difference between revisions of "Sandbox:Mitra"

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==Diagnosis==
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==Do's==
Shown below is an algorithm summarizing the diagnosis of <nowiki>[[disease name]]</nowiki> according the the [...] guidelines.
 
{{familytree/start |summary=PE diagnosis Algorithm.}}
 
{{familytree | | | | A01 | | | A01= Acute [[All patients with Inferior wall Myocardial Infarction]] (ST elevation in leads II, III and avF)}}
 
{{familytree | | | | |!| | | | }}
 
{{familytree | | | | B01 | | | B01= Assess Right-sided precordial leads}}
 
{{familytree | | | | |!| | | | }}
 
{{familytree | | | | C01 | | | C01=  <div style="float: left; text-align: left; width: 25em; padding:1em;">
 
>=1 mm ST elevation in V4R}}
 
{{familytree | | |,|-|^|-|.| | }}
 
{{familytree | | D01 | | D02 | D01= Yes | D02= No }}
 
{{familytree | |!| | | |!| | |}}
 
{{familytree | | D01 | | D02 | D01=
 
RVMI| D02= No RVMI}}
 
{{familytree | |!| | | |!| | |}}
 
{{familytree | | E01 | | E01=
 
Echocardiography: RV dilatation
 
RV wall akinesia or dyskinesia
 
Reversed septal curvature caused by thereversal of transpeptal pressure due to the increased LVEDP
 
Severe RA enlargement}}
 
  
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* [[Right ventricular myocardial infarction]] [[(RVMI)]] should be ruled out in all patients presenting with acute [[inferior wall myocardial infarction]], in particular in patients with [[hypotension]].
  
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*In patients presenting with [[chest pain]] and clinical findings of [[hypotension]], elevated [[JVP]] and clear lung fields, consider the differential diagnoses of [[RVMI]]. These include:
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**[[Pulmonary embolism]]
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**[[Pericarditis]] with [[pericardial tamponade]]
  
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*Systemic or pulmonary [[vasodilators]] may be considered in selected patients to reduce [[RV afterload]], thereby improving [[cardiac output]].
  
{{familytree/end}}
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*In patients with severe [[tricuspid regurgitation]] due to [[RVMI]], replacement of [[tricuspid valve]] or repair of the valve with annuloplasty rings may be considered.
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*In patients with [[RVMI]] who have unexplained [[hypoxemia]] despite administration of 100% oxygen, [[right-to-left shunting]] -through a [[patent foramen ovale]] or [[atrial septal defect]]-, caused by the disproportionate elevation in right-sided filling pressures compared to the normal or slightly increased left-sided filling pressures should be considered.
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*Patients with extensive [[necrosis]] due to [[RVMI]] may be at higher risk of [[right ventricular]] perforation during interventional procedures. [[Right ventricular catheterization]] or [[pacemaker]] insertion should be performed with great care in these patients.
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==Don'ts==
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* In patients with [[RVMI]], avoid preload-reducing agents such as [[nitrates]], [[diuretics]], [[morphine]], [[beta-blockers]], and [[calcium channel blockers]].

Revision as of 14:28, 2 August 2020

Do's

Don'ts