Fiona had a 40yo female patient today who presented with an episode of significant SOB while walking followed by a brief syncope. She had fibroid excision surgery February 2018. Previous surgery had lead to development of DVT. She was treated with clexane post operatively. She had noticed some calf pain over the weekend.
She was tachycardia 100 reg sats 92% on RA BP 114/57
CTPA revealed a saddle embolus
Cardiac ultrasound showed several features of massive PE.
PSAX: LV small and hyperdynamic. D shape to LV due to P overload in RV causing bowing of septum to L in systole.
PLAX showing a very dilated RV and hyper dynamic LV (kissing pap muscles). Note RV free was is not contracting much, there is not much change to RV cavity with systole.
PLAX hyper dynamic RV and LV due to sepsis for comparison