Describe the echocardiographic features not uncommonly seen in the patient with septic shock
1. ECHO exam may be normal
2. Sepsis induced cardiomyopathy:
- Left Ventricular contraction impairment which may be global or segmental. MASPE < 8mm
- EF < 52% in men and < 54% in women (2)
- Left ventricular diastolic dysfunction: Peak e’ velocity (cm/s) in early diastole measured using PW Doppler at lateral and septal basal regions and then averaged. Abnormal LV diastolic function suggested by e’ (septum) < 7 cm/s or e’ (lateral) < 10 cm/s
- Right ventricular systolic and diastolic dysfunction TAPSE <17 mm
- 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
- Echocardiography in shock management Anthony S. McLean
- Review Open Access Published: 04 May 2018 Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature Robert R. Ehrman, Ashley N. Sullivan, Mark J. Favot, Robert L. Sherwin, Christian A. Reynolds, Aiden Abidov & Phillip D. Levy Critical Care volume 22, Article number: 112 (2018)