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Assessment of left ventricular function in severe scorpion envenomation: combined hemodynamic and echo-Doppler study
Objective:
To assess left ventricular function in patients presenting with pulmonary edema following scorpion envenomation.
Design:
Cohort study.
Setting:
Medical intensive care unit of a teaching hospital.
Patients:
Nine consecutive adult patients stung by Androctonus australis and presenting with pulmonary edema entered the study. Fourteen normal volunteers comprised the control group.
Interventions:
Upon admission, all patients had right heart catheterization and, within the first 8 h, a Doppler echocardiographic study. Results of Doppler echocardiographic studies were compared to those of controls.
Measurements And Results:
Usual hemodynamic information (heart and vascular pressures, derived data and tissue oxygenation parameters), left ventricular dimensions and indicators of systolic function, and Doppler-derived parameters of left ventricular filling and diastolic function were obtained upon admission. Serial echocardiographic measurements were repeated daily until full clinical recovery (eight patients) or death (one patient). All patients had a hemodynamic profile of acute congestive heart failure (mean PAOP = 24 +/- 2 mmHg; mean SVI = 22 +/- 7 ml/m2; mean CI = 2.5 +/- 0.5 l/min/m2). However, SVR were not increased (mean = 22 +/- 3 U/m2). Left ventricle was hypokinetic in all patients with transient mitral regurgitation present in five patients. Left ventricular systolic function was markedly depressed (FS = 12 +/- 6%; EF = 26 +/- 12%). An associated diastolic dysfunction is suggested by Doppler records of mitral inflow. Left ventricular systolic function evolved toward normalization within 6 +/- 2 days preceded by full clinical recovery.
Conclusions:
These data suggest that pulmonary edema in scorpion envenomation is of hemodynamic origin and is related to a severe and prominent impairment of left ventricular systolic function.