Poster 1010: Acute right heart failure in septic shock

Background: In right ventricular dysfunction, it is well established that a decrease systolic function is a predictor of poor prognosis, including hospitalization and mortality associated with heart failure. Changes in chamber size, contractility, and diastolic function are expected. Patients die due to heart failure with degeneration of normal conduction

Methods: Analysis of a septic shock with presentation of acute right heart failure in patient with no comorbidities and suspect pregnancy

Outcome: A 31 years old women with no comorbidities.
Patient is admitted to the emergency room with an inespecific abdominal pain, fever, nausea and vomiting in multiple occasions, Also referring upper respiratory symptoms onset 72 hours prior admition. During examination, the patient presented a positive immunological pregnancy test, her last menstruation had been 5 weeks ago. Given the symptoms presented A diagnosis of septic shock of abdominal focus was made. She was transferred to the operating room due to suspected acute appendicitis, with no abdominal focus evident in surgery. A sonogram ruled out the presence of inter or extra uterine gestational sac.
A new CT scan was performed, which showed a pneumonic process. The patient was transferred to the intensive care unit, where she began to show respiratory distress. Broad-spectrum antibiotic therapy was started with partial improvement, however, she presented greater deterioration of the functional class, a viral profile was performed with a positive result for Rhinovirus and with elevated BNP. When performing an ETT, a TAPSE/PASP ratio of 0.4, PASP 43 and LVEF 57% were found. The management of heart failure was optimized and subsequently the patient presented clinical improvement.

Conclusion: Right heart failure is secondary to morphological changes; management in septic shock is based on fluids and antibiotics, after excessive fluid replacement on stressed myocardium, dilation can occur. TAPSE and PASP are tools used however the clinical picture must be integrated and evaluate the CVP, no greater than 8.