Fig. 7

Acute cor pulmonale in septic shock. Septic shock in community-acquired pneumonia superimposed on chronic pulmonary hypertension (pulmonary fibrosis). TEE midesophageal 4-chamber view (upper panels, Video 7A ESM) and transgastric midpapillary short axis view (lower panels, Video 7B ESM). SAP 100/53 mmHg, HR 123 bpm, low cardiac output. Norepinephrine [1 mcg/(kg min)] is infused. The RV looks markedly dilated (its end-diastolic area is bigger than the LV area (7A, RVEDA/LVEDA > 1), and hypokinetic (small reduction of its size from end-diastole, a, to end-systole, b). The interventricular septum is flattened (a, c) and shows a paradoxical motion at end-systole (b, d, red arrow). RA right atrium, RV right ventricle, LA left atrium, LV left ventricle, RVEDA RV end-diastolic area, LVEDA LV end-diastolic area