A 45 year old gentleman presents after 2 days of “indigestion” with a STEMI. He is admitted to ICU due to hypotension and an arterial line and pulmonary artery catheter are inserted. There are ongoing broad complex arrhythmias and urine output is poor. The first cardiac index is 1.5 l/min/m2 and the treating intensivist requests an echo….
Mitral valve in PLAX
Mitral valve with colour flow Doppler. Why does the degree of mitral regurgitation vary?
Incidentally, closer examination of the aortic valve in the first loop suggests a Lambl’s excrescence
PLAX (off axis). Which segments demonstrate regional wall motion (RWMA)? What is the object seen in the right ventricle?
X-plane through the basal LV, showing a SAX view of the mitral valve. Compare the function of the anterior and inferior walls.
Owing to the poor cardiac index (1.5 ml/min/m2), adrenaline was commenced at 5 μg/min. What change is seen in this PSAX at the mitral level?
The findings are summarized in this apical 2 chamber view, demonstrating poor function of the anterior wall and preservation of inferior wall function. Why is the apical inferior segment involved?
Echo is indicated where hypotension is of suspected cardiac origin, particularly post MI (ASE 2011 Appropriate Use criteria). In this case, an LV regional wall motion abnormality was found as expected. Hypotension post MI may also be due to complications such as RV failure, VSD, papillary muscle rupture with acute mitral regurgitation, and tamponade – which may be detected with echo.
Reviewer: Deirdre Murphy
Simultaneously published on echopraxis.com