Critical Care Echocardiography: Acute Left Ventricular and Valvular Dysfunction

Abstract

A rapid bedside critical care echocardiography (CCE) exam performed by an intensivist can provide an accurate dynamic assessment of left ventricular (LV) and valvular function and accordingly help direct resuscitative efforts. Basic CCE is goal oriented and uses five basic views (parasternal long and short axis, apical four-chamber, subxiphoid, and inferior vena cava views). The focus with basic CCE is to identify major, catastrophic causes of left ventricular failure or valve dysfunction that would affect the hemodynamic status of the critically ill patient. Advanced CCE, on the other hand, requires a comprehensive evaluation of hemodynamic parameters, mastery over image acquisition, and complete understanding of Doppler evaluation. The global visual assessment is the most common method used to estimate LV systolic function. LV systolic function can be categorized as normal, hyperdynamic, moderate dysfunction, or severe dysfunction. The estimation of stroke volume (SV) and cardiac output (CO) by echocardiography can also be a useful method for the assessment of LV systolic function in the critically ill patient. Valve function can be assessed using 2D echocardiography and color Doppler. Although goal-directed echocardiography can be invaluable in the care of critically ill patients, it is also paramount to recognize common pitfalls of CCE that can lead to flawed interpretations. With proper training and competence, intensivists can incorporate the findings from CCE into bedside clinical management strategies.