COTW October 20th: A 78 y/o F with severe shortness of breath

The patient arrives with rapid onset of shortness of breath developing over a couple of hours. She has no previously known cardiac history. She appeared critically ill and dyspneic. EMS reported initial systolic BP was in the 200s, so they administered NG and O2 supplement. Of course, during your resuscitation, you drop some gel on the chest and see…

Lots of B Lines…

More B Lines….

What about the heart?

A4CH shows normal systolic function, no pericardial effusion… what else can be wrong?

What if we add color doppler?

Hmm… notice the blue jet in the Left Atrium during systole representing flow away from the transducer (scale on the top left). Upon mitral valve closure, there should be minimal to no flow into the left atrium from the mitral valves. This finding is consistent with mitral regurgitation….

Could we quantify this for use in the clinical setting?

Sure! Here’s a simple cheat sheet:

Our images definitely show a color jet area involving more than 20% of the total LA area, consistent with at least moderate mitral regurgitation.

So… what happened with the patient?

She was quickly given IV diuresis, positive pressure ventilation, and IV vasodilators for aggressive afterload reduction resulting in rapid improvement of her condition. She was admitted to the ICU with cardiology consultation for definitive care.

Adding color doppler to your basic bedside echo is a quite simple tool that may provide useful information to your clinical information.