Ultrasound for Critical Care Physicians: Now My Heart Is Even More Full

Bilal Jalil, MD

Michel Boivin, MD

Division of Pulmonary, Critical Care and Sleep Medicine

University of New Mexico School of Medicine

Albuquerque, NM

A 49-year-old man with type 2 diabetes, intravenous drug abuse and heart failure presented to the emergency room with 2 weeks of progressively worsening chest pain, lower extremity swelling and shortness of breath. The patient was found to have an elevated troponin as well as brain natriuretic peptide and the absence of ischemic electrocardiogram findings. The patient was admitted to the medical ICU for hypoxic respiratory failure and shock of uncertain etiology. Clinically he seemed to be in decompensated heart failure and a bedside echocardiogram was performed (Figures 1 and 2).

Figure 1. Parasternal short axis view at the level of the aortic valve

Figure 2. Apical 4 chamber view.

What is the best explanation for the echocardiographic findings shown above? (Click on the correct answer for the explanation)

1. Atrial myxoma
2. Cardiac amyloidosis
3. Cardiac lymphoma
4. Takotsubo cardiomyopathy
5. Tricuspid valve endocarditis

Reference as: Jalil B, Boivin M. Ultrasound for critical care physicians: now my heart is even more full. Souhtwest J Pulm Crit Care. 2015;10(2):83-6. doi: http://dx.doi.org/10.13175/swjpcc020-15 PDF