Abstract
Objectives: To detect early diastolic dysfunction in the left ventricle in hypertensive patients with preserved ejection fraction using 2D speckle tracking echocardiography. Methods: This is a prospective study that was carried on (30) hypertensive patients referred to Al Azhar university hospital outpatient clinic for evaluation and treatment of hypertension and (20) age and sex matched healthy volunteers as a control group. All subjects underwent convential echocardiographic examination and Assesment of diastolic dysfunction by speckle tracking. Conclusion: Impairment of diastolic function detected by speckle tracking in hypertensive patients (with and without LVH)
Highlights
Central venous catheterization (CVC) is a routine technique done in critical care and emergency departments for monitoring patients and giving certain parenteral medications in special conditions
Most common complications associated with CVCs are infection, hematoma, hemothorax, pneumothorax and superior or inferior vena cava trauma while rare complications include cardiac arrhythmias, air embolism and loss of the guide wire [1]
Work-up for fever was unremarkable, mild renal impairment was accidentally diagnosed with Creatinine level of 2.8 mg/dl, fever subsided after giving intravenous antibiotics for 3 days the patient developed hypotension, blood pressure was 70/40 mmHg, heart rate was 140 beats per minute, electrocardiogram showed sinus tachycardia, liver enzymes were elevated, serum bicarbonate level was very low so the intensive care specialist inserted a central venous catheter to guide his fluid status control, central venous pressure was very low so he received intravenous fluids together with the antibiotics
Summary
Central venous catheterization (CVC) is a routine technique done in critical care and emergency departments for monitoring patients and giving certain parenteral medications in special conditions. Two days later the patient was referred to us again for follow up as he was still hypotensive with elevated central venous pressure. Work-up for fever was unremarkable, mild renal impairment was accidentally diagnosed with Creatinine level of 2.8 mg/dl, fever subsided after giving intravenous antibiotics for 3 days the patient developed hypotension, blood pressure was 70/40 mmHg, heart rate was 140 beats per minute, electrocardiogram showed sinus tachycardia, liver enzymes were elevated, serum bicarbonate level was very low so the intensive care specialist inserted a central venous catheter to guide his fluid status control, central venous pressure was very low so he received intravenous fluids together with the antibiotics. Chest X-ray was done a day later after central venous catheter insertion and astonishingly we found the introducing guide wire left inside his heart starting from the right internal jugular vein towards the right atrium and ventricle making a loop inside the pulmonary artery down through the inferior vena cava towards the hepatic vein. The lost wire was retrieved blindly without fluoroscopic guidance and follow-up X-ray showed no residual wire parts, he was Cardio Open, 2016
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