Case #5: What a difference a day makes

17 Dec

In this case you will see 2 echos from the same patient only 1 day apart.  The patient had raging septic shock from a skin source and was requiring significant hemodynamic support.  You can appreciate the cardiac dysfunction from a 2D point of view but also from a quantitative point of view.  The next day – you will see significant changes, now off inotropes (epinephrine, milrinone and norepinephrine).

*Images courtesy of Dr. Vincent Lau, critical care fellow, Western University

Case Highlights:

*Septic cardiomyopathy is a common cause of LV and/or RV dysfunction in the context of severe sepsis or septic shock

*Point-of-care echo can be used repeatedly to recognize  often rapid changes in cardiac function that occur during septic illness

*Quantitative stroke volume determination (using VTI from the LVOT) can additionally support your findings and guide management

For a similar case on septic cardiomyopathy, check out CHEST ultrasound corner here.

One Response to “Case #5: What a difference a day makes”

  1. Claudio Martin December 17, 2014 at 4:55 pm #

    Nice images. Dilated cardiomyopathy in sepsis was reported back in the 80’s to be associated with better likelihood of survival, presumably based on maintenance of stroke volume with reduced EF. With current approach to earlier resuscitation, do you ever see a septic patient with small AND hypokinetic LV? Conversely, if the evolution shown in this clip does not occur, probably not going to do well!

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