Table 1 Cases demonstrating clinical phenotypes
From: Mitral regurgitation in the critically ill: the devil is in the detail
Case 1: A 62-year-old male presenting to ED with severe respiratory failure and shock | Case 2: A 67-year-old female with escalating noradrenaline and FiO2 requirements post-emergency laparotomy |
|---|---|
2-day history of fevers and feeling generally unwell | 12-h following laparotomy and bowel resection for small bowel obstruction |
History of intravenous drug use (none for 3 months) | History of hypertension, type 2 diabetes mellitus and chronic kidney disease stage III |
Rapid escalation in FiO2 requirement and shock in the Emergency Department requiring intubation | Progressive rise in vasopressor and FiO2 requirement with cool peripheries |
Temperature 37.7°C, FiO2 0.6 (invasive mandatory ventilation), noradrenaline 0.2 mcg/kg/min, cool peripheries | Temperature 36.4°C, FiO2 0.5 at 50l flow via high flow nasal oxygenation, noradrenaline 0.4 mcg/kg/min |
Mildly elevated troponin. Lactate 11 | Chest X-Ray demonstrated bilateral pulmonary infiltrates |
Case 3: A 43-year-old with productive cough, chest discomfort and unilateral pulmonary infiltrates on chest X-Ray | Case 4: A 76-year-old female with non-retroviral pneumocystic jirovecii pneumonia with two failed spontaneous breathing trials |
|---|---|
24-h history of productive cough and fevers | 6 day admission to ICU requiring invasive ventilation for severe respiratory failure |
Evolving breathlessness since symptom onset | History of hypertension, dyslipidaemia and smoking |
History of antiphospholipid syndrome with multiple pulmonary emboli and an RCA myocardial infarction treated with drug eluting stents. Mildly elevated troponin, no new ECG changes | Previous TTE revealed mild mitral regurgitation |
FiO2 0.5 on CPAP 10Â cmH2O | Two spontaneous breathing trials resulted in tachycardia, hypertension, worsening hypoxaemia and bilateral pulmonary infiltrates |
Right sided coarse crackles on examination | Â |