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HYPOVOLAEMIA

The hypovolaemic patient with a normal heart, will have a hyperdynamic LV with a small contracted cavity. This is seen best in PLAx where the pap muscles almost strike each other with each systole (kissing pap muscles) and the anterior mitral leaflet hits the IV septum in diastole (EPSS <5mm). In keeping with this, the RV will be small and hyperdynamic and the IVC will be small and contract >50% with inspiration. (Note this is assuming a underlying normal heart) 

PLAx: kissing pap mucsles

tiny IVC in hypovolaemia

Repeating the echo after fluid resuscitation will show that the chambers have increased in size and that the IVC is more dilated. 

SEPSIS

Initially sepsis has the same features as hypovolaemia. However with worsening acidosis and/or aggressive fluid resuscitation, LV function deteriorates (1). The first sign of this is the gradual dilation of the LA due to increased LV diastolic pressure (2). Following this the LV will start to dilate and become hypocontractile. When you see the LA dilate: it is time to cease fluid resuscitation and start inotropes for hypotension. 

LV hypodynamic and LA dilated in a hypotensive acidaemic patient with nec fasc

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REFERENCES

1. L'Heureux M, Sternberg M, Brath L, Turlington J, Kashiouris MG. Sepsis-Induced Cardiomyopathy: a Comprehensive Review. Curr Cardiol Rep. 2020 May 6;22(5):35. doi: 10.1007/s11886-020-01277-2. PMID: 32377972; PMCID: PMC7222131.

2. Walley KR. Sepsis-induced myocardial dysfunction. Curr Opin Crit Care. 2018 Aug;24(4):292-299. doi: 10.1097/MCC.0000000000000507. PMID: 29846206.