scholarly journals Focused echocardiography in COVID-19: An unusual case of acute right ventricular dysfunction

Ultrasound ◽  
2020 ◽  
Vol 28 (4) ◽  
pp. 229-234
Author(s):  
Nishant Cherian ◽  
Charles Reynard ◽  
Richard Body
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Point Of Care ◽  
Disease Process ◽  
Right Ventricular Dysfunction ◽  
Point Of Care Ultrasound ◽  
Rapid Diagnostics ◽  
Right Ventricular Strain ◽  
Focused Echocardiography

Background During the novel coronavirus disease 2019 (COVID-19) pandemic, rapid diagnostics have been frequently sought to quickly evaluate a patient’s condition. Lung ultrasound can provide an early glimpse into the disease process and its severity. The addition of focused echocardiography can be particularly helpful in the haemodynamically compromised patient to detect myocardial involvement and alternative diagnoses. Case We discuss here a 53-year-old patient who presented to the Emergency Department with hypoxia and hypotension. Bedside focused ultrasound revealed signs of COVID-19 pneumonia with evidence of right ventricular strain, initially thought to be due to massive pulmonary embolism. A computed tomography scan confirmed the findings on ultrasonography, but surprisingly did not demonstrate a pulmonary embolism. Conclusion Point-of-care ultrasound in COVID-19 aided the diagnosis of affected organs and helped categorise the type of shock in this patient; however, right ventricular dysfunction should be interpreted with caution and may not be due to a pulmonary embolism, as in this case.

scholarly journals SIRS Triggered by Acute Right Ventricular Function, Mimicked Septic Shock

2019 ◽  
Vol 5 (4) ◽  
pp. 149-156
Author(s):  
Yingke He ◽  
John Ong ◽  
Thuan Tong Tan ◽  
Brian K. P. Goh ◽  
Sharon G. K. Ong
Keyword(s):  
Septic Shock ◽  
Right Ventricular ◽  
Inflammatory Markers ◽  
Ventricular Dysfunction ◽  
Point Of Care ◽  
Right Ventricular Dysfunction ◽  
Point Of Care Ultrasound ◽  
Case Presentation ◽  
Appropriate Treatment ◽  
Refractory Hypotension

Abstract Background The systemic inflammatory response syndrome (SIRS) is a complex immune response which can be precipitated by non-infectious aetiologies such as trauma, burns or pancreatitis. Addressing the underlying cause is crucial because it can be associated with increased mortality. Although the current literature associates chronic heart failure with SIRS, acute right ventricular dysfunction has not previously been reported to trigger SIRS. This case report describes the presentation of acute right ventricular dysfunction that triggered SIRS and mimicked septic shock. Case presentation A 70-year-old male presented to the Intensive Care Unit (ICU) with elevated inflammatory markers and refractory hypotension after a robotic-assisted laparoscopic radical choledochectomy with pancreaticoduodenectomy. Septic shock was misdiagnosed, and he was later found to have a pulmonary embolus. Thrombectomy and antimicrobials had no significant efect on lowering the elevated inflammatory markers or improving the persistent hypotension. Through Point of Care Ultrasound (POCUS), right ventricular dysfunction was diagnosed. Treatment with intravenous milrinone improved blood pressure, normalised inflammatory markers and led to a prompt discharge from the ICU. Conclusion Acute right ventricular dysfunction can trigger SIRS, which may mimic septic shock and delay appropriate treatment.

Shape-based analysis of right ventricular dysfunction associated with acute pulmonary embolism

2012 ◽  
Author(s):  
Nima Tajbakhsh ◽  
Wenzhe Xue ◽  
Hong Wu ◽  
Jianming Liang ◽  
Eileen M. McMahon ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction

McConnell’s Sign As An indicator of Right Ventricular Infarction: A Case Report

2021 ◽  
Author(s):  
Judah Nijas Arul ◽  
Preetam Krishnamurthy ◽  
Balakrishnan Vinod Kumar ◽  
Thoddi Ramamurthy Muralidharan ◽  
Senguttuvan Nagendra Boopathy ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Medical Management ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Right Ventricular Infarction ◽  
Coronary Syndrome ◽  
Pulmonary Angiogram ◽  
Ventricular Infarction

Abstract BackgroundMcConnell’s sign is a specific echocardiographic finding that was first described in patient with acute pulmonary embolism signifying right ventricular dysfunction. It remains an under-recognized sign in patients with right ventricular infarction.Case PresentationAn 80-year-old woman presented with sudden onset chest pain and breathlessness. The electrocardiogram showed features suggestive of inferior, posterior, and right ventricular infarction with complete heart block and McConnell’s sign was seen on the echocardiography. CT pulmonary angiogram ruled out the present of pulmonary thromboembolism. Coronary angiogram revealed an occluded right coronary artery with collateral supply from the left circulation. Medical management was planned after patient-physician discussion. Patient symptomatically improved with medical management.ConclusionAlthough McConnell’s sign is suggestive of acute pulmonary embolism, it may also be present in patients with right ventricular dysfunction due to infarction. The presence of McConnell’s sign in a patient presenting with acute coronary syndrome should prompt evaluation for right ventricular infarction in the absence of acute pulmonary embolism.

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