Critical Care
The Southwest Journal of Pulmonary and Critical Care publishes articles directed to those who treat patients in the ICU, CCU and SICU including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals. Manuscripts may be either basic or clinical original investigations or review articles. Potential authors of review articles are encouraged to contact the editors before submission, however, unsolicited review articles will be considered.
Ultrasound for Critical Care Physicians: Now My Heart Is Full
Sapna Bhatia M.D.
Rodrigo Vazquez-Guillamet M.D.
Division of Pulmonary, Critical Care and Sleep Medicine
University of New Mexico School of Medicine
Albuquerque, NM
A 65 year old woman with a history of hypertension and a recent diagnosis of multiple myeloma was admitted to the ICU with septic shock due to Morganella morganii bacteremia. She was treated with cefepime, levophed and dobutamine. During treatment she developed symptoms and a chest x-ray compatible with congestive heart failure. A transthoracic echo is shown below (Figures 1 and 2).
Figure 1. Parasternal long echocardiogram of the patient.
Figure 2. Apical four-chamber echocardiogram of the patient.
Additionally a spectral pulsed-wave Doppler study of the mitral inflow velocities is presented (Figure 3).
Figure 3. Pulsed-wave spectral Doppler velocities of the mitral-valve inflow of the patient.
What is the best explanation for the findings seen in on the echocardiogram? (Click on the correct answer to proceed to the next panel and explanation)
Reference as: Bhatia S, Vazquez-Guillamet R. Ultrasound for critical care physicians: now my heart is full. Southwest J Pulm Crit Care. 2014;9(5):291-4. doi: http://dx.doi.org/10.13175/swjpcc154-14 PDF
Ultrasound for Critical Care Physicians: Really, At Her Age?
A 71 year old woman presented with dyspnea since late 2013 and denies a prior history of dyspnea. She had a cardiac pacemaker placed in 2008 for sick sinus syndrome. Her physical exam was unremarkable and her SpO2 was 96% on room air. However, it decreased to 84% with exercise. Chest x-ray and pulmonary function testing were unremarkable (a DLco was unable to be performed). A transthoracic echocardiogram was performed (Figure 1).
Figure 1. Movie with Doppler flow of transthoracic echocardiogram.
Which of the following best explains the patient's dyspnea and hypoxia? (Click on the correct answer to proceed to the next panel)
- Cardiac tamponade
- Decreased cardiac contractility
- Intracardiac shunt
- Mitral insufficiency
- Ventilation perfusion mismatch from COPD
Reference as: Wesselius LJ. Ultrasound for critical care physicians: really, at her age? Southwest J Pulm Crit Care. 2014;8(5):278-9. doi: http://dx.doi.org/10.13175/swjpcc061-14 PDF