Thoughts? 3yr,25lb male, Cushionoid WHWT chronic cough. Sept.CT; alv consolidation vent lobes, mild Br. thickening, diffuse inst. pattern rest of lung parenchyma, mass assoc. R adr. Recent rads; inst. Pattern(on AB’s). R Hrt large. Echo: Mobitz type2 block?, trivial MV and TV reg, LV mildly increased(CI=1.7),LA:AO=wnl, AO=1.5m/s,E:A=1.1,Evel=.93m/s. RV=NAF?,no sig. RV pressure(TVreg 3m/s (poor) RPADI normal,no septal flattening/PSM, PA:AO=NAF).RV outflow was 1.0m/s with some slight notching, no hepatic congestion. Adrenals( brief- needs sed)LAdr= NAF, RAdr=round- no sig TD,1.45cm dia
Comments
Age typo. This fellow is actually 13 yrs. Thanks for having a look!
Hi Dan!
Not much to see here. Certainly no clinically relevant PHT. The most obvious change ist the AV-Block. I would always perform an atropine test to rule out vagal stimulation. If the patient is not collapsing, I would not do much in terms of his heart. The septum is rounded, so pressures in the RV are likely not significantly increased. If the patient collapses and the block ist not atropine-responsive, I would try Theophylline before I recommend a pacemaker.
Does this answer your question?
best wishes,
Peter