Acute left ventricular dysfunction in the critically ill

Anand Chockalingam, Ankit Mehra, Smrita Dorairajan, Kevin C Dellsperger

Research output: Contribution to journalReview article

48 Citations (Scopus)

Abstract

Acute left ventricular (LV) dysfunction is common in the critical care setting and more frequently affects the elderly and patients with comorbidities. Because of increased mortality and the potential for significant improvement with early revascularization, the practitioner must first consider acute coronary syndrome. However, variants of stress (takotsubo) cardiomyopathy may be more prevalent in ICU settings than previously recognized. Early diagnosis is important to direct treatment of complications of stress cardiomyopathy, such as dynamic LV outflow tract obstruction, heart failure, and arrhythmias. Global LV dysfunction occurs in the critically ill because of the cardio-depressant effect of inflammatory mediators and endotoxins in septic shock as well as direct cate cholamine toxicity. Tachycardia, hypertension, and severe metabolic abnormalities can independently cause global LV dysfunction, which typically improves with addressing the precipitating factor. Routine troponin testing may help early detection of cardiac injury and biomarkers could have prognostic value independent of prior cardiac disease. Echocardiography is ideally suited to quantify LV dysfunction and determine its most likely cause. LV dysfunction suggests a worse prognosis, but with appropriate therapy outcomes can be optimized.

Original languageEnglish (US)
Pages (from-to)198-207
Number of pages10
JournalChest
Volume138
Issue number1
DOIs
StatePublished - Jul 1 2010

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Left Ventricular Dysfunction
Critical Illness
Takotsubo Cardiomyopathy
Ventricular Outflow Obstruction
Precipitating Factors
Troponin
Critical Care
Acute Coronary Syndrome
Septic Shock
Tachycardia
Endotoxins
Echocardiography
Comorbidity
Cardiac Arrhythmias
Early Diagnosis
Heart Diseases
Heart Failure
Biomarkers
Hypertension
Mortality

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Chockalingam, A., Mehra, A., Dorairajan, S., & Dellsperger, K. C. (2010). Acute left ventricular dysfunction in the critically ill. Chest, 138(1), 198-207. https://doi.org/10.1378/chest.09-1996

Acute left ventricular dysfunction in the critically ill. / Chockalingam, Anand; Mehra, Ankit; Dorairajan, Smrita; Dellsperger, Kevin C.

In: Chest, Vol. 138, No. 1, 01.07.2010, p. 198-207.

Research output: Contribution to journalReview article

Chockalingam, A, Mehra, A, Dorairajan, S & Dellsperger, KC 2010, 'Acute left ventricular dysfunction in the critically ill', Chest, vol. 138, no. 1, pp. 198-207. https://doi.org/10.1378/chest.09-1996
Chockalingam A, Mehra A, Dorairajan S, Dellsperger KC. Acute left ventricular dysfunction in the critically ill. Chest. 2010 Jul 1;138(1):198-207. https://doi.org/10.1378/chest.09-1996
Chockalingam, Anand ; Mehra, Ankit ; Dorairajan, Smrita ; Dellsperger, Kevin C. / Acute left ventricular dysfunction in the critically ill. In: Chest. 2010 ; Vol. 138, No. 1. pp. 198-207.
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