about 50 y old patient was admitted to our hospital with weakness and indeterminate fever (> 38,9°C tympanal). Alkcohol addiction is known. We saw a tachypnoea, mild peripheral cyanosis and
tachykardia (atrial fibrillation with herat frequence of about 160 per minutes). We heard a loud diastolic heart murmur: decrescendo above 2. intercostal space right and holodiastolic murmur above 4.
intercostal space left).
Blood samples showed us severe infection with distinct elevated iinfammatory markers.
In TTE I saw the picture of aortic endocarditis with severe aortic insufficiency and a suspicion of mitral valve endocaditis.
about 80 y old patient with congestive heart failure and sepsis with pulmonary focus (gram-stain: gram-positive cluster coccal).
In TEE we found a floating structure an posterior leaf of mital valve. not typical for active endocarditis. What could it be? We thought it could be a residual of a former endocarditis or a calcified
residual of tendon of papillary muscle.
What do you think?
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.