Well yesterday I finally got the announcement in the mail. My registry exam window is now officially open until October 2010. After that month if I can’t get my registry completed, I might as well go back among the heap of those working for a pittance to survive.

For now I'm going for the CCI – RCS (Registered Cardiac Sonographer) credential. Testing the waters with this one will possibly give me a leg up for taking the much vaunted RDCS (Registered Diagnostic Cardiac Sonographer), the latter being supposedly the tougher of the two. Stay tuned to hear about my results. From what I understand the difference of the two is in it’s international acceptance and the RDCS has a traditional vascular component to it.

The test will be in two parts, ultrasound physics and echocardiography. From now until a date that I feel comfortable, I’ll have my review books with me. Looking over formulas and jotting down cardiac functions will be the very bane of my existence.

With 380 hours left to graduate, my externship should be completed by mid-august, giving substantial time to pass the test and be fresh meat for those suffering from heart conditions. Truth be told, I'll finally be a happy man when all of this is over and i can go on to live a productive life for me and my family.

I’m getting close to the period where my test date will arrive. the nights of studying and reading in between patients at the local echo lab will pay  off in spades. Getting a passing score and becoming certified as an echocardiographer looks to be within my grasp.

The sixth case I will review will be about a condition called “congenital aortic stenosis/regurgitation”.

History

A 21-year old male presents to the emergency room with complaints of dyspnea (shortness of breath) and extreme exhaustion upon exertion.There is no history of rheumatic fever, chest pain, orthopnea (difficulty breathing while lying down), or edema (excessive fluid). He complains of palpitations and recalls a prior doctor telling him his heart sounds are not normal.

Physical Examination

Blood pressure is 150/50 and pulse is 78 bpm. Pulses are noted to be prominent. A hyperdynamic left ventricular impulse is left of the midclavicular line. S1 and S2 are normal. a grade 2/6 systolic ejection murmur is heard at the right upper sternal border. A grade 4/5 diastolic decrescendo murmur is heard along the left sternal border. a brisk pulse is noted in the fingers that fades away suddenly. The EKG demonstrates LVH and the CXR shows mild-moderate cardiomegaly.

After reading this case, the main points of interest are what occurs during the physical exam. Listening and feeling the different heart sounds is a way of finding out which way to possible go for this diagnosis. An echocardiogram will let the cardiologist know the level of aortic stenosis or regurgitation, and how to progress. An enlarged heart can only make the internal structures perform less efficiently.

Acute pulmonary embolism (PE) is a common disease which frequently results in life threatening right ventricular (RV) failure. High-risk PE, presenting with hypotension, shock, RV dysfunction or right heart thrombus is associated with a high mortality, particularly during the first few hours. Accordingly, it is important to commence effective therapy as soon as possible.

In the case described in this report, a 49-year old woman with myotonic dystrophy type 1 presented with acute respiratory failure and hypotension. Transthoracic echocardiography showed signs of right heart failure
and a mobile right heart mass highly suspicious of a thrombus. Based on
echocardiographic findings, acute thrombolysis was performed resulting in
hemodynamic stabilization of the patient and complete resolution of the right heart thrombus.

This case underscores the important role of transthoracic echocardiography for the diagnosis, management and monitoring of PE and underlines the efficacy and safety of thrombolysis in the treatment of PE associated with right heart thrombus.