cardiogenic shock caused by STEMI
about 75 y old patient with dyspnoea and nausea 4 days ago, no chest pain; cardiovascular risk factors: arterial hypertension, diabetes mellitus type 2, hyperlipoproteinaemia. In ECG we could see
distinct ST-elevation in I, aVL, V2-V6 as a picture for an anterolaterale infarction, the index-event is 4 days ago; in TTE I could see a dinstinct impairment of myocardial function with
anteroapicale, lateral, septale and post./inf. akinesia; best-contraction in basal-septal, basal-lateral and basal-inf./post. segment. NO dynamic obstruction of LVOT caused by hyperdynamic basal
segments (very important to see it!!! in that case NO catecholamines, volume and cardioselective beta-blockers, for example esmolol will remedy the situation).
In LV-cavum you can see a ruptured tendon of mitral valve without severe mitral valve insufficiency.
Added: 1948 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: 2341 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: 2458 days ago
Is it a midventriculare Tako-Tsubo?
about 70 y old patient with high-malignant lymphoma, condition after multiple chemotherapy. Actually the patient was admitted to our ICU with the clinical picture of septic shock; first we found in
TEE and TTE the echocardiographic picture of hyperdynamic myocardial movement. Among current therapy of septic shock with norepinephrin, pitressin we could see another echocardiographic picture of the
patients heart. It looks like a midventriculare Tako-Tsubo caused by high dosed catecholamines. What do you think?
Added: 2444 days ago
septic shock in the context of severe lymphoma
about 70 y old patient; a severe lyphoma is known with condition after several chemotherapies, but there is still a progress of lymphoma. Actually the patient was admitted to our ICU with deep
hypotension and the clinical and laboratory cirterias of septic shock; focus of infection was pluriseptal pleural empyema an both sides. Notwithstandig therapy with calculated antibiotics, volume,
catecholamines, pirtessin and continuous veno-venous haemofiltration we couldn´t rescue the patient. In TEE we found no sign for endocarditis and a hyperdynamic left and right ventricle. Besides we
could see infiltration of lymphoma.
Added: 2443 days ago
Tako Tsubo cardiomyopathy
about 50 y old patient with severe posttraumatic stress disorder caused by death of near relative. The patient was admitted to out ER/ ICU with distinct and typical clinical affliction of acute
coronary syndrome. Troponine I 0,8 (normal till 0,023), CK 210 U/l. In ECG we could see repolarisation disturbance without signs of ST-elevations. In TTE you can see myocardial movent disorder of
apical LV-wall like an apical ballooning. No disturbance of RV. No US-B-lines, no pleural effusion, no sign of LVOTO despite the echocardiographic picture of hyperdynamic basal LV-wall-segments. In
cardiac catheter no sign of coronary disease; we could see in cardiac catheter the typical movement disorder of Tako-Tsubo-CM as we could see in TTE before.
One question to the community: Is there ALWAYS a need for cardiac catheter if we see the typical echocardiographic picture of apical ballooning/ Tako-Tsubo-CM?
Added: 2329 days ago