Case 56

70 yo F with pmhx of hypothyroidism, COPD, presents for evaluation of lower extremity edema, ongoing for the past 4 weeks, intermittent. No SOB, no chest pain, no back pain, no abdominal pain, no cough, no sputum,  no recent travel. Patient states that for the last 4 weeks, her legs have been swelling up which is relieved by her elevating it. Patient reports that she has been a smoker for 50 years. She was seen by her cardiologist this morning and sent in for further evaluation.

VS T 96.2 BP 195/85 P 82 RR 18 O2 99% on RA

Exam:

Gen: well-appearing, in no acute distress
CV: Normal S1 S2, regular rate and rhythm
Lung: clear to auscultation bilaterally. no wheezes, rhonchi, or rales
ABD: soft, non-tender, non-distended
Ext: bilateral LE 2+ pitting edema
Neuro: no focal neurological deficits

Bedside ECHO was performed.

Questions:

  1. What are the windows of a bedside ECHO?
  2. What do you see in this patient?
  3. Which chamber is affected?
  4. What are the next step in management of this patient?

Answers:

  1. Parasternal long, parasternal short, apical 4, and subxiphoid

  2. There is a clot noted in one of the chambers of the heart.

  3. The left ventricle

  4. This patient was anticoagulated with heparin and admitted to the CCU.  However, management depends on the vitals and clinical course.