Evaluation of left ventricular performance during sympathetic nervous storm in a case with severe tetanus by transesophageal M-mode echocardiography.

Transesophageal M-mode echocardiography was applied for the evaluation of left ventricular performance in a case of severe tetanus with labile hypertension due to sympathetic nervous 'storm'. When systemic blood pressure was elevated, increases in pulmonary arterial pressure, cardiac output, left ventricular enddiastolic diameter, fractional shortening and mean velocity of circumferential fiber shortening were noted. No changes were found in total peripheral vascular resistance or left ventricular endsystolic diameter. Positive pressure ventilation, rendered standard transthoracic echocardiography ineffective.