Bedside Echocardiography in Cardiogenic Shock: A Systematic Approach to Real-time Assessment

A 67-year-old patient with an unknown past medical history presents to the emergency department with altered mental status, dyspnea, and lower extremity edema. Vital signs on arrival are notable for a patient who is afebrile, heart rate of 113 bpm, blood pressure of 83/61 mmHg and an O2 saturation of 92% on 6L nasal cannula. Physical examination is notable for jugular venous distension, crackles bilaterally, normal S1 / S2 without overt murmurs, rubs or gallops, and cool extremities. Given your concern for cardiogenic shock, a Swan-Ganz catheter is placed, demonstrating a central venous pressure of 14 mmHg, pulmonary artery pressure of 55/29 mmHg (mean 38 mmHg), and a pulmonary capillary wedge pressure of 24 mmHg.