About 50 y old patient with atrial fibrillation (HR about 150-170/min); the patient told clinical afflictions in the course of time of 3 weeks. In TTE we found a distinct LV-motion disorder and
decrease of LV-EF. After exclusion of thrombus in LAA by TEE we did the elektrical cardioversion. After 1 week we saw a distinct improvement of LV-function.
Added: 640 days ago
septic shock with hypodynamic left ventricle
about 40 y old patient with B-ALL, condition after chemotherapy; now the patient had a mycotic septic shock caused by candida albicans. Probably infection caused by infected port-catheter in sup. vena
Added: 786 days ago
hyperdynamic septic shock with midventricular gradient
A about 50 y old patient was admitted to our ICU from another hospital with severe septic shock. It was known a HIV-infection for over 15 y. In TEE we had no indication of endocarditic vegetation, but
we could see a hyperdynamic RV and LV with a midventrcular gradient of the LV (> 2 m/sec).
Added: 777 days ago
septic shock with dynamic RVOTO and LVOTO
about 45 y old patient with septic shock, who was admitted to our ICU from another hospital. In TEE we could see a distinct biventriculare hypertrophy with dynamic RVOTO and LVOTO.
Added: 786 days ago
about 80 y old patient with dyspnoea. The patient was admitted to our internal ER from surgical ward. Condition after implantation of VVI-pacemaker in context of bradyarrhythmia absoluta (actually the
patient is pacemaker-dependent).
In TTE we found us-b-lines and distinct pleural effusion right.
There was alos a distinct decrease of cardial function, a severe pulmonary hypertension (RVSP about 65 mmHg) and a disorder of LV-compliance (approach to LVEDP about 20 mmHg; DecT 180 msec, E7A 2,3,
E-velocity about 1 m/s, E`-velocity 0,5 m/sec, E/E´about 20 mmHg, Velocity-prolongation about 0,36 m/sec). IVC 19-20 mm without undulation.
Added: 660 days ago
about 50 y old patient with dyspnoea and new diagnosed atrial fibrillation. In TTE we found a distinct decrease of myocardial function. In cardiac catheter there is no coronary disease.
Approach to cardiac output by echocardiography: about 3,2 - 3,5 l/min.
Added: 660 days ago
haemodynamic monitoring using echocardiography: a trial 2
about 60 y old patient with condition after operation of carcinoma of pancreas and chemotherapy. Actually the patient was admitted to our ER with severe oedema of lower limbs: no thromboses of IVC or
deep lower veins of both legs or V. iliacae. We found a severe lack of proteins, especially of albumin.
The patient was hypoton, tachycardiac and weak. No fever, no new heart murmur.
in TTE I found a hyperdynamic heart. Approach to cardiac output demonstrated a cardiac output of about 11,2 l/min (LVOT-diameter 19 mm, LVOT-VTI 42 cm, LVOT-velocity 1,76 m/s, heart rate 96-110/min).
There was a increase of flow in aortic valve looking like low-grade aortic stenosis, but the dimensionsless index was near 1,0 (0,97) showing that there is no aortic stenosis (AV Vmax 2,2 m/s, PGmean
11,2 mmHg). There was also a midventricular gradient and distinct collaps of IVC;
LVOT-VTI-variation was > 13% (I used that variation instead of delta pulse pressure-variation, because I did that echocardiography before tapping an artery)
There wasn´t an incease of LVEDP (E/A 0,88, E/E`about 6 mmHg, velocitiy-prolongation about 0,37 - 0,42 m/s, E´-velocity 0,15 m/s).
No us-b-lines or effusion of pleura.
After fluid-challenge despite of the severe oedema there was a stabilisation of haemodynamic.
Added: 660 days ago
RV-failure in septic shock
about 85 y old patient with known chronic RV-failure; actually the patient was admitted to our ICU from another ER with syncope and dyspnoea. NIV wasn´t effective, so we had to intubate and
mechanically ventilate the patient. In bronchoscopy we found a severe pulmonary infection in lower left lung (gram-stain: gram-negative rod cell and gram-positive coccal).
The patient needed high-dose catecholamines (norepinephrin, dobutamine, milrinon, amiodarone,pitressin, hydrocortisone); CVP of 13 > after volume CVP of 17 without profit of haemodynamic.
In TTE and TEE we saw a RV-overpressure with systolic septum-shift and no undulation of VCI: in TEE: no sign of thrombus in LAA, RAA or PA. besides we could see the pulmonary consolidation lower left
lung despite of former bronchoscopy.
volume-challenge wasn´t effective; over the course of time the patient was catecholamine-refraktory.
What do you think? Any other options in therapeutical treatment of RV-failure?
Added: 697 days ago
about 60 y old patient was admitted to our icu with typical clinical afflictions of ACS. Condition after transaortale septal myectomy in the case of HOCM for years. Actually we saw a distinct
LV-hypertrophy with midventricular gradient dependent on heart rate. In LVOT we could found a notable acceleration of flow but NO SAM or midsystolic closure of aortic valve. Under the therapy with
volume and beta-blocker (esmolol) we could see a rapidly haemodynamic improvement.
DON´T give that patient inotropics in cases of haemodynamic instability!
What do you think about? Make it sense to implantate a DDD-pacemaker to reach an asynchronous stimulation of the heart (with asynchronous contraction behavour/ cycle of right and left ventricle) to
moderate the ventricular gradients?
Added: 721 days ago
severe pulmonary embolism
young pregnant woman (38 WOP) with dyspnoea, tachycardia was admitted from another hospital to our icu.
We found the echocardiographic picture of an cute cor pulmonale with signs of decompensation. actually no catecholamines was needed.
We started anticoagulation with UFH (PTT > 60 sec) and decided to do the sectio with cardiac-surgery-standby. No lysis because of possibility of ablatio of placenta.
Added: 722 days ago