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ESRD patient with shortness of breath

A middle-aged patient on maintenance hemodialysis presents with shortness of breath. Patient was undergoing chemotherapy for a hematologic malignancy and compliant with dialysis sessions. Had normal ejection fraction on cardiology-performed echo 2 months ago. Here are the POCUS findings.

FoCUS (focused cardiac ultrasound) shows severely reduced left ventricular ejection fraction with global hypokinesis. Note trace pericardial effusion and reduced EPSS. No gross mitral or tricuspid regurgitation. Right ventricular systolic function seems to be preserved based on visual TAPSE.

Lung ultrasound demonstrates diffuse B-lines suggestive of pulmonary edema.

Inferior vena cava is enlarged and demonstrates ‘smoke’ (echogenic material indicative of sluggish circulation)

The new-onset heart failure was deemed to be non-ischemic in nature and was attributed to chemotherapy-related or stress-induced cardiomyopathy (not typical Takotsubo). The purpose of this case is to show some classic images as well as highlight that echo findings are dynamic, and you should perform FoCUS even if the patient has a recent echocardiogram.  


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