21yo patient with no past medical hx was referred to SSU for management of community acquired pneumonia.
PC: SOB, worse at night, cough, nil fevers
Ex RR 18 sats 99% on RA HR 119 BP 148/74
Would you send the patient to SSU based on the above CXR?
CXR (above) shows RUL patchy hyper densities: likely consolidation.
However, there is a very large cardiac silhouette for a PA film. No B lines or UL diversion.
Astute SSU consultant (Martin Dutch) did a bedside echo:
Subcostal 4 chamber shows a severely dilated hypodynamic LV, no pericardial effusion
Apical 4 chamber shows biventricular and biratrial enlargement. Severely decreased EF
The patient was admitted under AMU for further Ix of cardiomyopathy.
Formal echo: severe biventricular failure. LVEF 9%!! No shunts or cardiac anatomical anomaly found. ?viral cardiomyopathy.