Clinical Case Scenario
Mr. James Thornton, a 68-year-old male with a significant medical history of uncontrolled hypertension, diabetes, and chronic kidney disease on maintenance hemodialysis, presents to the emergency department with a 3-day history of productive cough, fever, and progressive dyspnea. On initial evaluation, he is febrile, tachypneic, and hypotensive with a mean arterial pressure (MAP) of 55 mmHg and a heart rate of 110/min. He has also become oliguric for the last 8 hours and continues to be hypotensive even after receiving a fluid bolus and norepinephrine infusion. Bedside point-of-care ultrasound was performed where the Doppler profile of the LVOT demonstrated a dagger-shaped appearance (Figure 1).
What is the most appropriate next step?
Figure 1. Continuous wave doppler across LVOT (Picture courtesy-Geske JB et al.Clin Cardiol 2009;32:397)
