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)  

1. Cardiac amyloidosis
2. Hypertensive heart disease
3. Hypertrophic cardiomyopathy
4. Stress (Takotsubo) cardiomyopathy

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