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Abstract
A 68-year-old patient was admitted in our hospital with on and off fever and cough for 1 month and disorientation for 5 days. On admission, patient was hemodynamically unstable and was unable to maintain saturation on 5 litre oxygen. Provisional diagnosis of sepsis induced AKI with encephalopathy was made. MRI Brain of the patient and CSF examination were normal while bedside 2D echocardiography revealed pressure and volume overload of right ventricle which led to low cardiac output state and hence likely the maintaining factor for disorientation. These echo findings helped in managing the inotropic and vasopressor support of the patient. Inotropic and vasopressor support was weaned over a period of 3-4 days and oral digoxin was added. To conclude, echocardiography is an important bedside tool to assess the cardiac performance. Altered mental status in patients with acute exacerbation of chronic obstructive pulmonary disease remains a pressing problem in the acute medical take. Bedside 2D echocardiography done at the right time by the intensivist remains a corner stone in the effective diagnosis and management of such patients.
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References
- Kolb TM, Hassoun PM. Right ventricular dysfunction in chronic lung disease. Cardiol Clin 2012;30(2):243-56.
- Jardin F, Gueret P, Prost JF, et al. Two-dimensional echocardiographic assessment of left ventricular function in chronic obstructive pulmonary disease. Am Rev Respir Dis 1984;129(1):135-42.
- Volpicelli G, Lamorete A, Tullio M, et al. Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med 2013;39(7):1290-8.
- Otto CM. Textbook of clinical echocardiography. 3rd edn. Philadelphia, PA: Elsevier Saunders 2004:256-72.
- Schmid E, Hilberath JN, Blumenstock G, et.al. Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy. Heart Lung Vessel 2015;7(2):151-8.
- Tan C, Rubenson D, Srivastava A, et al. Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort. Cardiovascular Ultrasound 2017;15(1):1-8.
- Sabia P, Afrookteh A, Touchstone DA, et al. Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction. A prospective study using two-dimensional echocardiography. Circulation 1991;84(3 Suppl):I85-92.
- Naeije R, Badagliacca R. The overloaded right heart and ventricular interdependence. Cardiovasc Res 2017;113(12):1474-85.
- Lin SS, Reynertson SI, Louie EK, et al. Right ventricular volume overload results in depression of left ventricular ejection fraction. Implications for the surgical management of tricuspid valve disease. Circulation 1994;90(5 Pt 2):II209-13.
- Bellomo R, Prowle JR, Echeverri JE. Diuretic therapy in fluid-overloaded and heart failure patients. Contrib Nephrol 2010;164:153-63.
References
Kolb TM, Hassoun PM. Right ventricular dysfunction in chronic lung disease. Cardiol Clin 2012;30(2):243-56.
Jardin F, Gueret P, Prost JF, et al. Two-dimensional echocardiographic assessment of left ventricular function in chronic obstructive pulmonary disease. Am Rev Respir Dis 1984;129(1):135-42.
Volpicelli G, Lamorete A, Tullio M, et al. Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med 2013;39(7):1290-8.
Otto CM. Textbook of clinical echocardiography. 3rd edn. Philadelphia, PA: Elsevier Saunders 2004:256-72.
Schmid E, Hilberath JN, Blumenstock G, et.al. Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy. Heart Lung Vessel 2015;7(2):151-8.
Tan C, Rubenson D, Srivastava A, et al. Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort. Cardiovascular Ultrasound 2017;15(1):1-8.
Sabia P, Afrookteh A, Touchstone DA, et al. Value of regional wall motion abnormality in the emergency room diagnosis of acute myocardial infarction. A prospective study using two-dimensional echocardiography. Circulation 1991;84(3 Suppl):I85-92.
Naeije R, Badagliacca R. The overloaded right heart and ventricular interdependence. Cardiovasc Res 2017;113(12):1474-85.
Lin SS, Reynertson SI, Louie EK, et al. Right ventricular volume overload results in depression of left ventricular ejection fraction. Implications for the surgical management of tricuspid valve disease. Circulation 1994;90(5 Pt 2):II209-13.
Bellomo R, Prowle JR, Echeverri JE. Diuretic therapy in fluid-overloaded and heart failure patients. Contrib Nephrol 2010;164:153-63.