Answer 6

The image is a TG SAX view of the mid-papillary view of the LV. The EDA is normal, but the ESA is smaller than normal. Notice that the papillary muscles are “kissing”. Thus the FAC is high, correlating with increased EF. So the ventricle is filling normally, but it is ejecting a higher than normal stroke volume, which would fit with low SVR (vasodilatation).

In the setting of fecal peritonitis this hemodynamic state most likely reflects septicemia. Treatment would include ensuring adequate antibiotic therapy is in place, fluid and vasoconstrictor. Norepinephrine would be the vasopressor of choice in sepsis. If the patient continues to deteriorate repeat washout of the abdomen may be indicated.