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Bedside IVC Echocardiography to Distinguish Autonomic Dysfunction-Predominant Orthostasis From Right Ventricular
Ivan Nenadic1, Alexandria Danyluk1, Karen Flores Rosario1
1Duke Heart Center, Duke University, Durham, North Carolina, USA.
Objective:
To present a bedside echocardiography approach using inferior vena cava size and collapsibility to distinguish between autonomic dysfunction-predominant orthostatic hypotension and right ventricular failure in symptomatic continuous-flow left ventricular assist device patients.
Key Steps:
Identify patients with a continuous-flow left ventricular assist device and presenting orthostatic intolerance symptoms or low-flow alarms. Perform bedside echocardiography evaluating inferior vena cava size and collapsibility while the patient is supine, and again after standing for 3 to 5 minutes. Categorize findings. Right ventricular failure: Indicated by a plethoric, poorly collapsible inferior vena cava. Autonomic dysfunction-predominant orthostatic hypotension: Indicated by a small, highly collapsible inferior vena cava.
Potential Pitfalls:
Failing to optimize volume status and device parameters prior to testing may lead to unclear or inaccurate clinical assessments.
Take-Home Messages:
Autonomic dysfunction orthostatic hypotension is a frequently underrecognized complication of continuous-flow left ventricular assist device support caused by reduced pulsatility. Bedside assessment of inferior vena cava collapsibility serves as a method to identify the underlying phenotype and guide clinical management.
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