A Case of Reverse McConnell's Sign Associated With Acute Respiratory Distress Syndrome and Septic Shock

Area of Science:

• Cardiology
• Critical Care Medicine

Background:

• Reverse McConnell's sign is a rare echocardiographic finding characterized by right ventricular apical hypokinesis and basal hyperkinesis.
• This sign is typically associated with massive pulmonary embolism or takotsubo cardiomyopathy.

Observation:

• A case of reverse McConnell's sign was identified in a patient experiencing acute respiratory distress syndrome and septic shock.
• The echocardiographic finding was attributed to increased right heart afterload caused by hypoxic pulmonary vasoconstriction.

Findings:

• Cardiac function improved and normalized as the patient's respiratory failure and sepsis resolved.
• The presence of reverse McConnell's sign aided in initiating diuresis and establishing a baseline for monitoring cardiac function.

Implications:

• This case suggests that reverse McConnell's sign may indicate acutely increased right ventricular afterload more broadly, not just specific diagnoses.
• Early echocardiography is valuable for guiding management in critical illness, particularly when reverse McConnell's sign is detected, prompting focus on reversible causes of elevated right heart pressure.