An elderly gentleman presented with fevers, cough and hypotension. Peripheries were warm.
The LV is hyperdynamic with the walls “kissing”. There is a small pericardial effusion (which is of no haemodynamic significance)
Hyperdynamic left ventricle
A small, hyperdynamic LV can be seen in sepsis, anaphylaxis and also massive PE. The lack of RV enlargement and septal flattening exclude PE from the diagnosis. In the setting of hypotension or shock, the patient should be given IV fluid.