CHEST Guidelines-A-Hyperdynamic-Left-Ventricle-on-Echocardiogram

A-Hyperdynamic-Left-Ventricle-on-Echocardiogram_ch

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This medical case study in the journal "CHEST" discusses a 56-year-old woman with hypertension and morbid obesity who presented with chest pressure and shortness of breath. Her initial evaluation showed lowered oxygen saturation and elevated heart rate and blood pressure. Diagnostic tests, including an echocardiogram and pulmonary ultrasound, revealed an enlarged and hypodynamic right ventricle (RV) and a hyperdynamic left ventricle (LV). Such findings suggested acute right-sided heart failure rather than sepsis, prompting further investigation for pulmonary embolism (PE).<br /><br />The patient was diagnosed with PE, confirmed by a CT scan, and treated with high-flow oxygen, heparin, and intraarterial clot-dissolving medications, improving her condition. The study emphasizes the importance of careful assessment with point-of-care ultrasonography (POCUS) in differentiating causes of RV failure and the significance of recognizing a hyperdynamic LV as an indicator of decreased preload rather than sepsis or hypovolemia. This misdiagnosis might lead to catastrophic treatment errors.<br /><br />Hyperdynamic LV findings should be interpreted alongside RV size and function to guide appropriate management. If RV failure presents, potential causes, such as acute PE or right-sided myocardial infarction, versus chronic conditions like pulmonary hypertension, need differentiation to prevent life-threatening outcomes. The study concludes that proper evaluation of RV and LV dynamics in such clinical scenarios can lead to accurate diagnosis and effective treatment, avoiding errors in managing conditions that mimic sepsis or hypovolemia. The authors highlight the significant role of POCUS in emergency settings to provide timely and critical diagnostic insights.

Keywords

pulmonary embolism

right-sided heart failure

point-of-care ultrasonography

hyperdynamic left ventricle

right ventricle dysfunction

diagnostic imaging

emergency medicine

pulmonary hypertension

hemodynamic assessment

chest pressure