Hypotension

In critically ill patients it is imperative to resolve and treat the cause of haemodynamic shock as quickly as possible in order to save lives and minimize end-organ damage. Intensive Care doctors trained to perform echocardiography can rapidly diagnose and effect management changes in hypotensive patients. A goal-directed approach is required seeking to urgently identify and differentiate distinct clinical syndromes that may occur in this setting. Such an approach utilizes the primary transthoracic echocardiographic subcostal, parasternal, and apical windows and identifies the key issues that can be addressed in the available views. Key to the success of goal-directed echocardiography is the integration of clinical and echocardiographic data in each individual patient. Keeping an open mind regarding the coexistence of more than one cause of hypotension and the need for more comprehensive echocardiography testing is important. Specific situations such as papillary muscle rupture, localized tamponade following cardiac surgery and prosthetic valve malfunction are more reliably diagnosed using the transoesophageal approach. Some diagnoses, such as aortic dissection, acute mitral or aortic regurgitation and acute cardiomyopathy require a multidisciplinary approach and immediate consultation with Cardiology and cardiothoracic services will be required. The simultaneous interpretation of echocardiographic images and the institution of active management are what distinguish critical care echocardiography.