Here is a comparison⚖️of Invasive vs. Non-Invasive hemodynamics using #CrititicalCareEcho #VEXUS #POCUS
62 M/HFrEF 20% in CCU for cardiogenic shock. On 4L NC. Also + for RSV infection🫁 On dobutamine drip.
No pedal edema
JVD, Crackles, B lines +
Worsening renal function. Net -ve 10 L so far.
Bedside US done ~2 hours prior to RHC:
62 M/HFrEF 20% in CCU for cardiogenic shock. On 4L NC. Also + for RSV infection🫁 On dobutamine drip.
No pedal edema
JVD, Crackles, B lines +
Worsening renal function. Net -ve 10 L so far.
Bedside US done ~2 hours prior to RHC:
VEXUS:
(Rhythm A fib)
IVC- 2.8 cm, <10% collapse
HV- S wave reversal, on comparison with IRVD
PV ~50% pulsatility
IRVD- Monophasic Discontinuous
Grade: 3 - Severe congestion
(Rhythm A fib)
IVC- 2.8 cm, <10% collapse
HV- S wave reversal, on comparison with IRVD
PV ~50% pulsatility
IRVD- Monophasic Discontinuous
Grade: 3 - Severe congestion
CO from LVOT VTI = 2.9
Afib here->chose an average looking waveform
Afib here->chose an average looking waveform
SVR estimated based on MRVmax/LVOT VTI ratio. (3.8/8.48) = 0.45
(>0.27 correlates with > 1120 dynes per onlinejase.com)
(>0.27 correlates with > 1120 dynes per onlinejase.com)
RHC:
Following RHC, Diuretic regimen was aggressively escalated, later clinical course improved.
Following RHC, Diuretic regimen was aggressively escalated, later clinical course improved.
Summary:
NONINVASIVE
Preload: Severe congestion
CO: 2.9
Afterload: SVR > 1120 dynes
(Monophasic IntraRenal doppler also explains diuretic resistance here)
INVASIVE
NONINVASIVE
Preload: Severe congestion
CO: 2.9
Afterload: SVR > 1120 dynes
(Monophasic IntraRenal doppler also explains diuretic resistance here)
INVASIVE
Another HV Doppler:
S Wave reversal better seen here. Thanks to @ArgaizR
S Wave reversal better seen here. Thanks to @ArgaizR
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