Elderly male patient with recent ankle fracture and ORIF presents with chest pain and hypotension.
You consider acute myocardial ischaemia and pulmonary embolism your most likely diagnoses.
The features typical of massive PE in this case include:
- Dilated poorly functioning RV (Subcostal, PSSX and Ap4ch views)
- Distended IVC that does not collapse at all with inspiration reflecting raised right sided pressures
- RV apical tip still contracting well (best seen on Ap4ch view)
- Empty, hyperdynamic LV with flattening of the interventricular septum
With focussed echo in the critically ill patient one can differentiate the various causes of hypotension very rapidly.
In this case myocardial infarction, PE, cadiomyopathy, tamponade and critical valve disease were all considered and a diagnosis attained very rapidly.