Question 5: septic shock

Describe the echocardiographic features not uncommonly seen in the patient with septic shock

1. ECHO exam may be normal

2. Septic cardiomyopathy:

  • Left ventricular dilatation : if  LV EDD > 5.5cm however dependent of size of patient. If patient is an athlete LVEDD may be increased and normal.   Measure in PLAX view using calipers – need to be at 90 degrees to myocardium at tip of mitral valve
  • Left Ventricular contraction impairment which may be global or segmental
  • Left ventricular diastolic dysfunction
  • Right ventricular systolic and diastolic dysfunction
  • SV decreased LVOT VTI < 18 cm

3. LVOT obstruction

  • Ventricular outflow obstruction if sigmoid septum or ventricular hypertrophy  and small LV cavity

4. Valves

  • Functional problems such as  SAM (systolic anterior motion)
  • Endocarditis

Most common abnormality is small hyperdynamic LV best seen in PLAX and PSAX view “kissing ventricle”

5. LVOT VTI PW Doppler exam :

  • Early LVOT VTI >22 cm
  • Late LVOT VTI may be < 18 cm (hypovolaemic, cardiomyopathy)
  • Increase in LVOT VTI of > 15% if fluid responsive

6. IVC

  • IVC may be <1 cm collapsing > 50% – suggestive of underfilling
  • IVC > 2cm and collapsing <50% suggests high right ventricular pressures cardiomyopathy

Reference

  1. Echocardiography in shock management Anthony S. McLean

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