Fig. 6

Septic shock after preload and afterload optimization, unmasking sepsis-related myocardial dysfunction. Same patient of Fig. 1 (hospital-acquired pneumonia, 3rd postoperative month of double-lung transplant), 18 h later, after volume resuscitation, infusion of norepinephrine [1 mcg/(kg min)], vasopressin 0.02 U/min, now again unstable (SAP 90/60, HR 121 bpm, low cardiac output). TTE subcostal 4-chamber view (upper panels, Video 6A ESM) and parasternal short axis midpapillary view (middle panels, Video 6B ESM) show a severely depressed LV systolic function with negligible reduction of LV size from end-diastole (a, c) to end-systole (b, d). RV shows preserved systolic function. The IVC (subcostal IVC view, lower panels) is now larger (e) with absent inspiratory increase at mechanical passive inspiration (f). RA right atrium, RV right ventricle, LA left atrium, LV left ventricle, IVC inferior vena cava, SAP systemic arterial pressure, HR heart rate