about 85 y old patient with known severe COPD; intermittent paroxysmal AF is also known, condition after DDD-pacemaker-implantation in another hospital because of BTS and chronotropic incompetence.
Actually the patient was admitted to our icu after severe hypoxaemia and therefor resulting sudden cardiac arrest with cardiopulmonary resusciation.
In TEE we found a distinct RV-failure and RV-hypertrphy.
The left ventricle had an ejection fraction about 50%, we found a notable LV-hypertrophy and diastolic impairment (deceleration-time about 500 msec, E/A 0,7, E/E´about 10-12 mmHg. Tei-index > 0,5, E`< A`).
The pw-flow in mitral-valve-position showed a distinct reduction of LV-influx (distinct decrease of E-wave) with serious deterioration of haemodynamic during phases of paroxysmal AF in comparison with sinus rhythm.
Volume, inotropics, amiodarone and - after 4 days - sildenafil: we could find a mild improvement of the right ventricle and actually a stabile haemodynamic situation.