Podcasts about cardiogenic

N Engl J Med 2017;377:2419-2432Background: A small fraction of patients with acute myocardial infarction (5-10%) have cardiogenic shock. These patients have a high baseline mortality. Early revascularization had been established as better than initial stabilization with medical therapy. Many patients with cardiogenic shock due to acute myocardial infarction (AMI) have multivessel disease. The question arises about whether to do culprit-only percutaneous coronary intervention (PCI) or more complete PCI at the time of the initial intervention.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial was designed to test the hypothesis that PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, would result in better clinical outcomes than immediate multivessel PCI among patients who have multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock.Patients: The trial enrolled 706 patients with acute myocardial infarction (ST-segment elevation or non-ST-segment elevation) complicated by cardiogenic shock who had multivessel coronary artery disease. Cardiogenic shock was defined as SBP < 90 mmHg for more than 30 minutes or requiring pressors, clinical signs of pulmonary congestion, and signs of organ hypoperfusion (altered mental status, cold/clammy skin, oliguria, or lactate > 2 mmol/L).Exclusion criteria were extensive and designed to exclude patients with extremely poor prognosis: prolonged resuscitation, no intrinsic heart action, fixed dilated pupils, an indication for urgent CABG, a mechanical cause of shock, age > 90 years, massive pulmonary embolism, or severe renal insufficiency at baseline.Baseline Characteristics: The median age was 70 years, and approximately 75% were male. About 63% of patients had three-vessel disease. More than half the patients had ST-segment elevation myocardial infarction (about 62%), and anterior ST-segment elevation MI accounted for approximately 54% of these cases. About 53% of patients required resuscitation before randomization. The median left ventricular ejection fraction was between 30-33%.Procedures: In the culprit-lesion-only PCI group, only the culprit lesion was treated during the initial procedure, with staged revascularization encouraged based on residual ischemic lesions. In the multivessel PCI group, PCI of all major coronary arteries with >70% stenosis was performed, including attempts to recanalize chronic total occlusions. Crossover from the culprit-lesion-only PCI group to the multivessel PCI group occurred in 12.5% of patients, while crossover in the opposite direction happened in 9.4% of patients. The overall dose of contrast material was significantly higher and the duration of fluoroscopy significantly longer in the multivessel PCI group. Other interventional therapeutic measures were allowed, independent of the assigned treatment strategy.Endpoints: The primary endpoint was a composite of death from any cause or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Secondary endpoints included the individual components of the primary endpoint, recurrent myocardial infarction, rehospitalization for heart failure, repeat revascularization, time to hemodynamic stabilization, catecholamine therapy duration, ICU stay duration, and measurements of renal and myocardial injury. Safety end points included bleeding, which was defined as type 2, 3, or 5 on the Bleeding Academic Research Consortium (BARC) scale.Trialists estimated an event rate of the composite primary endpoint of 38% in the culprit-only group vs 50% in the complete group. Using a global type I error level of 0.05, the authors calculated that a sample of 684 patients would give the trial 80% power to rule out the null hypothesis of no difference between the two treatment groups in the event rate for the primary end point.Results: At 30 days, the composite primary endpoint occurred in 45.9% of patients in the culprit-lesion-only PCI group versus 55.4% in the multivessel PCI group (relative risk, 0.83; 95% CI, 0.71 to 0.96; P=0.01). Death occurred in 43.3% of the culprit-lesion-only PCI group versus 51.6% of the multivessel PCI group (relative risk, 0.84; 95% CI, 0.72 to 0.98; P=0.03). The rate of renal-replacement therapy was 11.6% in the culprit-lesion-only PCI group and 16.4% in the multivessel PCI group (relative risk, 0.71; 95% CI, 0.49 to 1.03; P=0.07).Rates of recurrent myocardial infarction, rehospitalization for heart failure, bleeding, and stroke did not differ significantly between groups. Subgroup analyses showed consistent results across all prespecified subgroups. The time to hemodynamic stabilization, the use of catecholamine therapy and the duration of such therapy, the duration of the ICU stay, and the use of mechanical ventilation and the duration of such therapy also did not differ significantly between the two groups.Conclusion: In patients with myocardial infarction and cardiogenic shock, culprit-only PCI was superior to multivessel PCI. Both components of the primary endpoint, death and severe renal failure were lower in the culprit-only arm. The authors and editorialists speculate why these findings contrast with trials in hemodynamically stable myocardial infarction patients, where early multivessel PCI showed benefit over culprit-only PCI.If you accept the thesis that multi-vessel PCI was superior to culprit-only PCI in stable AMI patients, the likely reason for the disparate results are that patients with cardiogenic shock differ substantially from stable patients. The sicker patients with cardiogenic shock benefit from a less-is-more approach where culprit-only PCI reduces treatment harm relative to multivessel PCI.We at CardiologyTrials, however, find the evidence for complete revascularization in stable AMI patients less than clear. The COMPLETE trial found benefit from multivessel PCI over culprit-only, but both composite endpoints were driven largely by non-fatal MI. CV death was not substantially different. The difference in MI could have been related to excluding procedure-related MI.What's more, the FULL-REVASC trial, which also compared culprit-only and multivessel PCI, failed to replicate the COMPLETE trial results. In FULL-REVASC the rates of the composite primary outcome of death, MI or unplanned revascularization were not significantly different. Sadly, FULL-REVASC was stopped early when COMPLETE results were published, which led to a possible loss of power.It's possible, likely even, that the null results of CULPRIT-SHOCK are not really that disparate from prior trials in patients with more stable AMI.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Join here for an insightful discussion with Federico Pappalardo, MD and Sanket Dhruva, MD, FACC on the groundbreaking ALT-SHOCK 2 RCT, the largest randomized trial on intra-aortic balloon pump therapy in heart failure cardiogenic shock. Learn about the trial's key findings, implications for clinical practice, and the future of mechanical circulatory support in this critically ill patient population.

Dhruv Kazi, MBBS, MS, FACC and first author Mohammed Essa, MD, discuss their newly published JACC Brief Report presented at ACC.25 on cardiac rehabilitation following myocardial infarction, with a focus on patients who experience cardiogenic shock. JACC: Associate Editor Jason H. Wasfy, MD, MPhil, FACC, asks questions to explore the significant underutilization of cardiac rehab, the impact of social determinants of health, and potential policy changes to improve access and outcomes. Join the conversation as they highlight key findings and the need for innovative solutions in cardiovascular care. #jacc #jaccjournals #acc25

Dhruv Kazi, MBBS, MS, FACC, and first author Mohammed Essa, MD, discuss their newly published JACC Brief Report presented at ACC.25 on cardiac rehabilitation following myocardial infarction, with a focus on patients who experience cardiogenic shock. JACC: Associate Editor Jason H. Wasfy, MD, MPhil, FACC, asks questions to explore the significant underutilization of cardiac rehab, the impact of social determinants of health, and potential policy changes to improve access and outcomes. Join the conversation as they highlight key findings and the need for innovative solutions in cardiovascular care.

In this video discussion with JACC: Associate Editor Michelle M. Kittleson, MD, PhD, FACC, and authors Eric Hall, MD and James A. de Lemos, MD, FACC, they review this study published in JACC & presented at ACC.25. Do patients who survive cardiogenic shock have neurocognitive consequences at intermediate-term follow-up? New cognitive impairment is common at discharge and 3 months after CS and is associated with worse quality of life and functional status. #jacc #jaccjournals #acc25

In this brief report from the BMC2 registry published in JACC and presented at ACC.25, Eric Cantey, MD, FACC, and Celina Yong discuss the study findings. In light of the DanGer Shock Trial, there is a need to define the current practice patterns in the care of AMI-CS. There is overall low annual case volumes of AMI-CS with significant heterogeneity in the intraprocedural utilization of MCS and RHC.

In this episode, recorded live at the Critical Care Canada Forum in Toronto, we dive into extracorporeal life support (ECLS) in cardiogenic shock, with Dr Sean van Diepen. He is an Associate Professor at the University of Alberta, Co-Director of the CCU at the Mazankowski Alberta Heart Institute, and a leading voice in cardiac critical care. Join us as we explore the evolving landscape of mechanical circulatory support, the latest evidence from the DANGER and ECLS-SHOCK trials, and the complexities of patient selection. Key Topics Covered:1. The Evolution of ECLS in Cardiogenic Shock • The 25-year gap since the last positive cardiogenic shock trial. • How mechanical circulatory support expanded despite limited evidence.2. The DANGER Trial – Impella in AMI-Associated Cardiogenic Shock • Mechanism and function of the Impella device. • Trial results: 20% mortality reduction at 180 days. • Complications: Limb ischemia, hemolysis, and high costs. • Real-world application: Who actually qualifies?3. ECLS-SHOCK Trial – ECMO for Cardiogenic Shock • A "negative" trial, but a crucial wake-up call. • No mortality benefit but significantly higher complication rates. • Controversies: Inclusion of cardiac arrest patients and transition to destination therapy. • Future directions: Can patient selection improve outcomes?4. ECPR – Extracorporeal Support in Refractory Cardiac Arrest • Review of the ARREST, PRAGUE, and INCEPTION trials. • Why the evidence remains unclear and institution-dependent. • The role of high-volume ECMO centers and standardized pathways.5. The Future of ECLS – Cost, Ethics, and Decision-Making • How should institutions decide who gets ECMO? • The role of cardiogenic shock teams. • Could AI play a role in decision-making? • The challenge of resource allocation in a single-payer system.Key Takeaways:✅ Impella shows promise in carefully selected AMI shock patients but is costly and high-risk.✅ ECMO for cardiogenic shock remains controversial—patient selection is key.✅ ECPR is promising but needs further trials and structured implementation.✅ Cardiogenic shock management should be a team decision, not an individual one.

Cardiogenic shock is a devastating condition with a persistent 50% mortality rate. However, groundbreaking treatments and technologies are now dramatically improving survival odds. Join Shane Turner as he sits down with Jason Weatherly, Cardiogenic Shock Commercial Marketing Manager at Abiomed, to explore these advancements and the life-saving impact of the Impella device.Jason highlights the recent DanGer Shock RCT, which confirmed that Impella CP® with SmartAssist® improves survival by 12.7%. Together, they delve into how these medical breakthroughs are crucially linked to critical care transport, emphasizing innovative strategies that are essential for enhancing patient outcomes and shaping the future of cardiogenic shock treatment.In this episode:Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TNJason Weatherly, Cardiogenic Shock Commercial Marketing Manager at Abiomed

In this podcast, Dr. Valentin Fuster discusses a study on the use of the microaxial flow pump (Impella) in treating older patients with cardiogenic shock following a myocardial infarction. The findings suggest that while the Impella pump can reduce mortality in younger patients, its effectiveness diminishes in those over 77, highlighting the need for age-based patient selection to optimize outcomes in this complex condition.

If you thought ARDS was a long episode... get ready for a marathon! This week on Critical Care Time, Cyrus and Nick take on the unenviable task of trying to cover everything you need to know about cardiogenic shock - at least in broad strokes - in ONE episode! That's right, this is your one-stop-shop for all things cardiogenic shock. While we will have some deep dives on RV and LV failure, as well as ECMO and other mechanical circulatory support options - this episode has a little bit of it all to wet your whistle and then some! We deconstruct the epidemiology of cardiogenic shock, do a deep dive on the SCAI classes of cardiogenic shock, talk pathophysiology (duh!) and then move on to treatment considerations - both medical and mechanical - followed finally by some cases to cement all the learning. We know this is a long one so feel free to listen/watch in chunks. However you decide to enjoy it, we are certain you will walk away from it ready to conquer the next CGS case you come across! Once you've finished this epic - leave us a review and let us know how we did! Hosted on Acast. See acast.com/privacy for more information.

In this episode of the Saving Lives Podcast, we review a nationwide study on cardiogenic shock in general ICUs, recently published in the European Heart Journal: Acute Cardiovascular Care. Discover why non-ischemic heart failure now leads cardiogenic shock admissions, which patient groups face the highest mortality, and how early ICU intervention can improve outcomes. Stay tuned for critical insights into managing this high-risk population. The Vasopressor & Inotrope Handbook I have written "The Vasopressor & Inotrope Handbook: A Practical Guide for Healthcare Professionals," a must-read for anyone caring for critically ill patients (check out the reviews)! You have several options to get a physical copy. Amazon: ⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠ (Affiliate Link) My Store: ⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠ (Use "podcast" to save 10%) Citation: Citation: Guido T, Giovanni T, Elena G, Anna Z, Michele Z, Stefano F. Cardiogenic shock in general intensive care unit: a nationwide prospective analysis of epidemiology and outcome. Eur Heart J Acute Cardiovasc Care. 2024 Dec 3;13(11):768-778. doi: 10.1093/ehjacc/zuae108. PMID: 39302432.

Dr. Trina Augustin, assistant professor of both anesthesiology and perioperative medicine as well as emergency medicine takes us on a deep dive into the care of persons with aortic stenosis. In this chapter, Alex and Venk learn about how to use ultrasound to diagnose AS, the keys to resuscitation, the pathophysiology of this condition, as well as the value of consultative services and the potential interventions that they may unlock for these patients. Kickoff season 4 with this in depth reminder that sometimes the heart has many hidden perils beyond ACS.  CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @KatrinaJoyAugustin Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Lichtenstein DA, Meziere GA. Relevance of Lung Ultrasound in the Diagnosis of Acute Respiratory Failure. Chest 2008; 134:117-125 Walsh MH, Smyth LM, Desy JR, Fischer EA, Goffi A, Li N, Lee M, St-Pierre J, Ma IWY. Lung Ultrasound: A Comparison of image interpretation accuracy between curvillinear and phased array transducers. Australia J Ultrasound Med, 26:150-156 Alzahrani H, Woo MY, Johnson C, Pageau P, Millington S, Thiruganasambandamoorthy V. Can severe aortic stenosis be identified by emergency physicians when interpreting a simplified two-view echocardiogram obtained by trained echocardiographers? Crit Ultrasound J. 2015 Apr 18;7:5. doi: 10.1186/s13089-015-0022-8. PMID: 25932319; PMCID: PMC4409610. Furukawa A, Abe Y, Morizane A, Miyaji T, Hosogi S, Ito H. Simple echocardiographic scoring in screening aortic stenosis with focused cardiac ultrasonography in the emergency department. J Cardiol. 2021 Jun;77(6):613-619. doi: 10.1016/j.jjcc.2020.12.006. Epub 2020 Dec 29. PMID: 33386216. Lin J, Drapkin J, Likourezos A, Giakoumatos E, Schachter M, Sarkis JP, Moskovits M, Haines L, Dickman E. Emergency physician bedside echocardiographic identification of left ventricular diastolic dysfunction. American Journal of Emergency medicine  Ehrman RR, Russell FM, Ansari AH, Margeta B, Clary JM, Christian E, Cosby KS, Bailitz J. Can emergency physicians diagnose and correctly classify diastolic dysfunction using bedside echocardiography? Am J Emerg Med. 2015 Sep;33(9):1178-83. doi: 10.1016/j.ajem.2015.05.013. Epub 2015 May 21. PMID: 26058890.2021;44:20-25 Del Rios M, Colla J, Kotini-Shah P, Briller J, Gerber B, Prendergast H. Emergency physician use of tissue Doppler bedside echocardiography in detecting diastolic dysfunction: an exploratory study. Crit Ultrasound J. 2018 Jan 25;10(1):4. doi: 10.1186/s13089-018-0084-5. PMID: 29372430; PMCID: PMC5785451. Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, de Waha A, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Lauer B, Böhm M, Ebelt H, Schneider S, Werdan K, Schuler G; Intraaortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) trial investigators. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013 Nov 16;382(9905):1638-45. doi: 10.1016/S0140-6736(13)61783-3. Epub 2013 Sep 3. PMID: 24011548. Aksoy O, Yousefzai R, Singh D, Agarwal S, O'Brien B, Griffin BP, Kapadia SR, Tuzcu ME, Penn MS, Nissen SE, Menon V. Cardiogenic shock in the setting of severe aortic stenosis: role of intra-aortic balloon pump support. Heart. 2011 May;97(10):838-43. doi: 10.1136/hrt.2010.206367. Epub 2010 Oct 20. PMID: 20962337. Karatolios K, Chatzis G, Luesebrink U, Markus B, Ahrens H, Tousoulis D, Schieffer B. Impella support following emergency percutaneous balloon aortic valvuloplasty in patients with severe aortic valve stenosis and cardiogenic shock. Hellenic J Cardiol. 2019 May-Jun;60(3):178-181. doi: 10.1016/j.hjc.2018.02.008. Epub 2018 Mar 21. PMID: 29571667. Gottlieb M, Long B, Koyfman A. Evaluation and Management of Aortic Stenosis for the Emergency Clinician: An Evidence-Based Review of the Literature. J Emerg Med. 2018 Jul;55(1):34-41. doi: 10.1016/j.jemermed.2018.01.026. Epub 2018 Mar 7. PMID: 29525246.  

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on characteristics and outcomes of patients with valvular cardiogenic shock.

CardioNerds (Dr. Yoav Karpenshif – Chair of the CardioNerds Critical Care Cardiology Council) join Dr. Munim Khan, Dr. Shravani Gangidi, and Dr. Rachel Goodman from Tufts Medical Center's general cardiology fellowship program for hot pot in China Town in Boston. They discuss a case involving a patient who presented with stress cardiomyopathy leading to cardiogenic shock. Expert commentary is provided by Dr. Michael Faulx from the Cleveland Clinic. Notes were drafted by Dr. Rachel Goodman. A young woman presents with de novo heart-failure cardiogenic shock requiring temporary mechanical circulatory support who is found to have basal variant takotsubo cardiomyopathy.  We review the definition and natural history of takotsubo cardiomyopathy, discuss initial evaluation and echocardiographic findings, and review theories regarding pathophysiology of the clinical syndrome. We also highlight complications of takotsubo cardiomyopathy, with a focus on left ventricular outflow obstruction, cardiogenic shock, and arrythmias. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Takotsubo cardiomyopathy is defined as a reversible systolic dysfunction with wall motion abnormalities that do not follow a coronary vascular distribution. Takotsubo cardiomyopathy is a diagnosis of exclusion; patients often undergo coronary angiography to rule out epicardial coronary artery disease given an overlap in presentation and symptoms with acute myocardial infarction. There are multiple echocardiographic variants of takotsubo. Apical ballooning is the classic finding, but mid-ventricular, basal, and biventricular variants exist as well. Patients with takotsubo cardiomyopathy generally recover, but there are important complications to be aware of.  These include arrhythmia, left ventricular outflow tract (LVOT) obstruction related to a hyperdynamic base in the context of apical ballooning, and cardiogenic shock. Patients with Impella devices are at risk of clot formation and stroke. Assessing the motor current can be a clue to what is happening at the level of the motor or screw. Notes What is Takotsubo Syndrome (TTS)? TTS is a syndrome characterized by acute heart failure without epicardial CAD with regional wall motion abnormalities seen on echocardiography that do not correspond to a coronary artery territory (see below).1 TTS classically develops following an acute stressor—this can be an emotional or physical stressor.1 An important feature of TTS is that the systolic dysfunction is reversible.  The time frame of reversibility is variable, though generally hours to weeks.2 Epidemiologically, TTS has a predilection for post-menopausal women, however anyone can develop this syndrome.1 TTS is a diagnosis of exclusion. Coronary artery disease (acute coronary syndrome, spontaneous coronary artery dissection, coronary embolus, etc) should be excluded when considering TTS. Myocarditis is on the differential diagnosis. What are the echocardiographic findings of takotsubo cardiomyopathy? The classic echocardiographic findings of TTS is “apical ballooning,” which is a way of descripting basal hyperkinesis with mid- and apical hypokinesis, akinesis, or dyskinesis.3 There are multiple variants of TTS. The four most common are listed below:3(1) Apical ballooning (classic TTS)(2) Mid-ventricular variant(3) Basal variant (4) Focal variant Less common variants include the biventricular variant and the isolated right ventricular  variant.3 Do patients with TTS generally have EKG changes or biomarker elevation? Patients often have elevated troponin, though the severity wall motion abnormalities seen on TTE i...

Show notes by Heather Lean ACP, BSc ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠podcast.RnRRounds.ca⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Show notes by Heather Lean ACP, BSc ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠podcast.RnRRounds.ca⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

In the September 10, 2024, JACC issue, Dr. Valentin Fuster discusses a pivotal study on cardiogenic shock, revealing that early and frequent reassessment within the first 24 hours is crucial for predicting patient outcomes. The study underscores the critical nature of early intervention and highlights the rapid progression seen in many patients, emphasizing the need for timely and continuous monitoring to improve survival rates.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on resource Utilization and Costs Associated with Cardiogenic Shock Complicating Myocardial Infarction in a Population-Based Cohort Study

Commentary by Dr. Candice Silversides

Cardiogenic Shock Recognition   Guest: Jacob C. Jentzer, M.D. Hosts: Sharonne Hayes, M.D.   Cardiogenic shock is a major cause of death and disability for patients with acute cardiac disease. Early recognition of cardiogenic shock is essential to allow timely intervention to avoid complications. Contemporary research and evolving definitions can facilitate the recognition of subtle manifestations of cardiogenic shock with the goal of improving patient outcomes.   Topics Discussed: What are the common manifestations of cardiogenic shock that can enable early recognition? Can patients meet criteria for cardiogenic shock even if they are normotensive? How have research efforts at Mayo Clinic contributed to understanding the recognition of cardiogenic shock? Are there any systems at Mayo Clinic to facilitate early recognition of cardiogenic shock?   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.  

Written by: Dr. Vijay Gupta (Internal Medicine Resident) Reviewed by: Dr. Sabe De (Cardiologist) and Dr. Karen Geukers (General Internist)Support the Show.

Cardiogenic shock accounts for up to 5% of acute heart failure presentations and around 14–16% of patients reported in cardiac intensive care datasets. It complicates up to 15% of all myocardial infarctions and is the leading cause of death post-infarction. Using pharmacological agents alone may increase left ventricular afterload and myocardial oxygen demand, resulting in complications. Thus, mechanical circulatory support (MCS) devices have emerged as important therapeutic options. As evidence remains uncertain, MCS selection depends on clinician preference and local availability.An updated systematic review and meta-analysis of high-quality RCTs and propensity score-matched studies (PSMs) was performed to compare the outcomes of MCS devices with no MCS and each other and investigate which MCS is the most effective in reducing mortality.To learn more about the findings of this study listen to this podcast.

ESC TV Today brings you concise analysis from the world's leading experts, so you can stay on top of what's happening in your field quickly. This episode covers: Cardiology This Week: A concise summary of recent studies Long-term beta blockers after myocardial infarction Pros and Cons of the microaxial pump in cardiogenic shock Snapshots Host: Perry Elliott Guests: Stephan Achenbach, Carlos Aguiar, Michael Boehm, Lene Holmvang Want to watch that episode? Go to: https://esc365.escardio.org/event/1151   Disclaimer This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. Declarations of interests Stephan Achenbach, Michael Boehm, Lene Holmvang and Nicolle Kraenkel have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, Lilly, Novartis, Pfizer, Sanofi, Servier, Tecnimede. Davide Capodanno has declared to have potential conflicts of interest to report: Abbott Vascular, Novo Nordisk, Sanofi. Terumo, Medtronic. Emma Svennberg has declared to have potential conflicts of interest to report: institutional research grants from Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Boehringer-Ingelheim, Johnson & Johnson, Merck Sharp & Dohme.

CardioNerds Dr. Josh Saef and Dr. Tommy Das join Dr. Omkar Betageri, Dr. Andrew Geissler, Dr. Philip Lacombe, and Dr. Cashel O'Brien from the Maine Medical Center in Portland, Maine to enjoy an afternoon by the famous Portland headlight. They discuss a case of a patient who presents with obstructive cardiogenic shock. Dr. Bram Geller and Dr. Jon Donnelly provide the Expert CardioNerd Perspectives & Review segment for this episode. Dr. Maxwell Afari, the Maine Medical Center cardiology fellowship program director highlights the fellowship program. Audio editing by CardioNerds Academy Intern, student doctor Tina Reddy. This is the case of a 42 year-old woman born with complicated Tetralogy of Fallot repair culminating in a 29mm Edwards Sapiens (ES) S3 valve placement within a pulmonary homograft for graft failure who was admitted to the cardiac ICU for progressive cardiogenic shock requiring vasopressors and inotropic support. Initial workup showed lactic acidosis, acute kidney injury, elevated NT-proBNP, and negative blood cultures. TTE showed at least moderate biventricular systolic dysfunction. She was placed on furosemide infusion, blood cultures were drawn and empiric antibiotics initiated. Right heart catheterization demonstrated elevated right sided filling pressures, blunted PA pressures with low PCWP, low cardiac index, and low pulmonary artery pulsatility index. Intracardiac echocardiography (ICE) showed a large mass within the ES valve apparatus causing restrictive valve motion with a low gradient across the pulmonic valve in the setting of poor RV function. Angiography revealed a large filling defect and balloon valvuloplasty was performed with immediate hemodynamic improvement. Blood cultures remained negative, she was gradually weaned off of inotropic and vasopressor support, and discharged. Despite empiric treatment for culture negative endocarditis and ongoing anticoagulation, she was readmitted for recurrent shock one month later at which time the pulmonic mass was revisualized on ICE. A valve-in-valve transcatheter pulmonary valve (29mm ES S3) was placed to compress what was likely pannus, with an excellent hemodynamic result and no visible mass on ICE. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media Pearls - Obstructive Cardiogenic ShocK Tetralogy of Fallot is the most common cyanotic defect and can lead to long term complications after surgical repair including chronic pulmonary insufficiency, RV dysfunction, residual RVOT obstruction and branch pulmonary artery stenoses. Chronic RV failure may be more indicative of a structural defect and therefore require interventional or surgical management. Valve thrombosis, infective endocarditis and obstructive pannus formation should be considered in the differential of a patient with obstructive shock with a prosthetic valve. Bioprosthetic pulmonic valve obstruction may be effectively managed with balloon valvuloplasty in patients who present in acute extremis but TCPV will likely provide a more lasting result. While valvular gradients are typically assessed via echocardiography, invasive hemodynamics can serve as a critical adjunctive tool in its characterization. Show Notes - Obstructive Cardiogenic ShocK Notes were drafted by Drs. Omkar Betageri, Philip Lacombe, Cashel O'Brien, and Andrew Geissler. What are the common therapies and management for Tetralogy of Fallot? Tetralogy of Fallot is the most common cyanotic defect in children beyond the age of one year Anatomic Abnormalities: Anterior and Superior deviation of the conal septum creating a SubAo VSD and encroachment on the RVOT.

In this in-depth episode, cardiac nursing expert Sean from the Nurse Dose Podcast vividly illustrates how acute coronary syndromes, valve dysfunction, arrhythmias, and mechanical complications can all culminate in cardiogenic shock. You'll learn to spot the ominous signs like falling cardiac output, rising filling pressures, and poor end-organ perfusion. But most importantly, Sean equips you with the critical interventions - from revascularization to advanced circulatory support devices like balloon pumps and Impella pumps. Whether you're an ICU nurse or just want to solidify your knowledge of this high-stakes condition, this masterclass on cardiogenic shock is a must-listen. This episode is part of Nurses' PodCrawl 2024. Check out other episodes from these excellent nurse podcasters: Obstructive Shock: Critical Care Scenarios and Rapid Response RN Distributive shock: Straight A Nursing and How Not to Kill Your Patient Hypovolemic shock: The Q Word Podcast and Up My Nursing Game From this episode: Listen to the Nurse Dose Podcast Check out Nurse Dose on IG! @NurseDosePodcast Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products. Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse: Get 15% off of her resume and cover letter templates using the promo code UPMYGAME Nursing students and new grad career services  Experienced RN career services NP career services

Happy Nurses Week! I was lucky enough to be invited to participate in the 2024 podcrawl where we talk about all things SHOCK. Annie from "Up My Nursing Game!" and I teamed up to bring you a deep dive into CARDIOGENIC SHOCK! I am sure you could have guessed it but this is my favorite form of shock to talk about. Be sure to check out all the other podcasters and their episodes on the different types of SHOCK! Critical Care Scenarios How Not to Kill Your Patient The Q Word Podcast Rapid Response RN Straight A Nursing Up My Nursing Game ICU Device Cheat Sheets and Crash Courses! (20% off during Nurses Week!) Instagram: @nursedosepodcast This podcast is intended for informational and educational purposes only. It is not intended to provide medical advice or to substitute for the advice provided by your own physician or other medical professionals. The information contained herein is not intended to diagnose, treat, cure, or prevent any disease. If you have any concerns or questions about your health, you should always consult with a physician or other healthcare professional. The opinions expressed in this podcast are those of the host and guests and do not necessarily reflect the views of any medical institution, organization, or employer. By listening to this podcast, you agree to hold harmless the host, guests, and any associated parties from any and all liability or damages arising from your use of the information provided.

ACC.24: DanGer Shock Trial

Pharmacotherapy in the Critically Ill Pregnant Patient: Part I Special Guests: Allison Lankford, MD Melissa Thompson Bastin, PharmD, PhD, BCCCP, FCCM, FCCP @mtbastin   08:05 – PK/PD changes 12:50 – Medication safety/Drug information resources 20:15 – Maternal sepsis 33:15 – ARDS 43:15 – PADIS 48:45 – Cardiogenic shock & cardiac arrest 59:00 – VTE   Pharmacotherapy “Caring for two in the ICU” articles: Part I: https://pubmed.ncbi.nlm.nih.gov/36938691/ Part II: https://pubmed.ncbi.nlm.nih.gov/37323102/   PharmacyToDose.Com @PharmacyToDose PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Impact of Cardiac Arrest Before Randomization on the Efficacy of ECLS in Patients With Infarct-Related Cardiogenic Shock. A Sub-Analysis of the Prospective EClS-Shock Trial (AHA 2023)

Commentary by Dr. Valentin Fuster

Take Home Points: Know clinical (cold extremities, oliguria, confusion, dizziness, narrow pulse pressure) and laboratory markers (metabolic acidosis, elevated creatinine, lactic acidosis) of hypoperfusion. An elevated lactate is a danger sign and requires explanation. Norepinephrine is a great first line vasopressor in Cardiogenic shock. Dobutamine is useful for inotropic support in Cardiogenic shock. Use POCUS ... Read more The post REBEL Core Cast 115.0 – Cardiogenic Shock appeared first on REBEL EM - Emergency Medicine Blog.

Cardiac surgery poses unique challenges with its risks for patients, its potential complications and the difficulty in capturing the details in thorough documentation. On this episode, we discuss those challenges and how to approach them effectively.   Moderator: Tomas Villanueva, DO, MBA, FACPE, SFHM Senior Principal Clinical Operations and Quality Vizient Guest: Rachel Mack, MSN, RN, CCDS, CDIP,  CCS, CRC Consulting Director Clinical Documentation Improvement Vizient   Show Notes: [01:04] Uniqueness of cardiac surgery [01:30] Cardiopulmonary bypass and extracorporeal circulation [02:27] Postoperative issues [05:08] Cardiac surgeons and documentation [06:13] Intra-aortic balloon pumps and cardiogenic shock [07:50] Cardiogenic acute renal failure [08:31] Arrythmias and pacing [09:10] The end of the road in intervention [11:08] Document the reason for a patient's deterioration Resources: To contact Modern Practice: modernpracticepodcast@vizientinc.com Rachel's email: rachel.mack@vizientinc.com   Subscribe Today! Apple Podcasts Amazon Podcasts Android Google Podcasts Spotify RSS Feed

AHA23 Congress Coverage: Cardiogenic Shock in Women

Host Sarah Lorenzini and Christian Guzman APRN are back to conclude this three-part heart failure series by examining the use of mechanical circulatory support for cardiogenic shock. This episode expands on the topics covered in previous parts, focusing on the application of mechanical circulatory support methods like the intra-aortic balloon pump, Impella, CentriMag, LVADs, and ECMO.Christian and Sarah review the risks and benefits of each device, when to use them, and the key factors that impact these decisions. They also address the ethical challenges of ECMO, including the clinical judgment involved when determining who's a good candidate and when to escalate care.By the end of this episode, you'll understand how these devices function, their critical role in managing cardiogenic shock in heart failure patients, and the value nurses bring to a multidisciplinary team.Tune in for a knowledge-packed finale of this comprehensive heart failure series!Topics discussed in this episode:The role of mechanical circulatory support devicesBenefits and risks of the intra-aortic balloon pump and Impella deviceHow to properly use Impella devicesCentriMag and Left Ventricular Assist Devices (LVADs)The evolution of permanent LVADsExtracorporeal Membrane Oxygenation (ECMO) for cardiac supportChallenges and ethical considerations of ECMOThe importance of nursing knowledge and confidenceConnect with Christian Guzman APRN on Instagram:https://www.instagram.com/thenerdynursepractitioner/Watch this episode on The Rapid Response RN YouTube Channel! https://www.youtube.com/@therapidresponsern/videosMentioned in this episode:Coming Soon! Rapid Response Academy: The Heart and Science of Caring for the SickClick here to learn more about the community that Sarah is building: https://www.rapidresponseandrescue.com/coming-soon-rapid-response-academy Rapid Response and Rescue Intro CourseCONNECT

Building on last week's introduction to heart failure, this episode explores the nuances in the medical management of cardiogenic shock. Host Sarah Lorenzini and Christian Guzman APRN continue this three-part heart failure series by completing the case study of a patient in cardiogenic shock, and breaking down key treatment concepts and strategies.They discuss goal-directed therapy to optimize heart function, with a specific focus on the vital aspects of contractility, afterload, and preload, and their pivotal roles in patient care. As their conversation progresses, they delve into the use of medical interventions, covering the pros and cons of medications used to treat heart failure at each stage from beginning to extremis.Christian and Sarah go beyond what you'll read from textbooks, shedding light on the challenges and clinical decision-making process of heart failure care by sharing real life examples and insights.Tune in now to learn how to assess patients for cardiogenic shock and manage their care at every stage of heart failure!Topics discussed in this episode:The treatment of last week's patientGoal-directed therapy for heart failureMethods to increase contractilityPreload optimizationThe use of inotropes in heart failure managementAssessing patients for cardiogenic shockWhen to use beta blockers for heart failureWhen to pull the trigger for mechanical circulatory supportConnect with Christian Guzman APRN on Instagram:https://www.instagram.com/thenerdynursepractitioner/Watch this episode on The Rapid Response RN YouTube Channel! https://www.youtube.com/@therapidresponsern/videosMentioned in this episode:Rapid Response and Rescue Intro CourseCONNECT

An epi pen owned by the patient may actually be helpful in the resuscitation of a patient experiencing anaphylactic shock.  There's also a discussion around the thought, "Patients don't suddenly deteriorate. Healthcare providers suddenly notice." A cardiogenic shock discussion then winds up the episode.

Dr. Donald Spaner sits in with us for the month of November to talk all of the levels and types of shock.  There's a lot to unpack in this episode! Assessment, prevention and treatment of. Cardiogenic shock  Hypovolemic shock  Anaphylactic shock  Septic shock  Neurogenic shock  Distributive shock

In this episode, Dr. Zanotti discusses advances in the management of cardiogenic shock. His guest is Dr. Jacob Jentzer, a cardiac intensivist trained in both Cardiology and Critical Care Medicine who practices full-time in the Cardiac Intensive Care Unit at Mayo Clinic in Rochester, MN. As the Director of Cardiac Intensive Care Unit Research at Mayo Clinic, he is active in Intensive Care Unit patient outcomes research, with a particular focus on the outcomes of patients with cardiogenic shock and cardiac arrest. Additional Resources Concise Definitive Review: Advances in the Management of Cardiogenic Shock. Jentzer JC et al. Crit Care Medicine 2023: https://pubmed.ncbi.nlm.nih.gov/37184336/ SCAI clinical expert consensus statement on the classification of cardiogenic shock. Baran DA, et al.: https://www.ncbi.nlm.nih.gov/pubmed/31104355 SCAI stages of cardiogenic shock stratify mortality risk. Jentzer JC et al.: https://www.ncbi.nlm.nih.gov/pubmed/?term=SCAI+stages+of+cardiogenic+shock+stratify+mortality+risk Advances in the Staging and Phenotyping of Cardiogenic Shock: Part 1. Jentzer JC, et al. JACC Advances 2022: https://www.jacc.org/doi/10.1016/j.jacadv.2022.100120 Machine Learning Approaches for Phenotyping in Cardiogenic Shock and Critical Illness: Part 2. Jentzer JC, et al. JACC Advances 2023: https://www.jacc.org/doi/10.1016/j.jacadv.2022.100126 Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. ECLS-SHOCK Investigators. New Eng J of Med 2023: https://pubmed.ncbi.nlm.nih.gov/37634145/ Book Recommendations: The Hobbit by JRR Tolkien: https://bit.ly/44S0tZD The Lord of the Rings Trilogy by JRR Tolkien: https://bit.ly/45Q9NP0 The House of God. By Samuel Shem: https://bit.ly/48gnusc

Join us in | 42 | as we kickoff the foundation for several up and coming episodes revolving around the subject of cardiogenic shock. In this episode, Jason and Brandon discuss the basic pathophysiologic principles of cardiogenic shock, and how it differs both in diagnosis and treatment from other more prominent forms of shock. This episode also features a recent classification system that categorizes phases of cardiogenic shock to help the clinician determine treatment, destination decision, and patient acuity. Use the cover art to follow along as Jason breaks down each category.  Check out www.scai.org and www.medicclasscitizen.com for more information. 

Commentary by Dr. Valentin Fuster

It's well known that emotions can affect the heart - we've all had an anxiety-producing thought that leads to the feeling of our heart pounding out of our chest. But what about the opposite: can the heart control our emotions? In today's episode of Beyond the Abstract, Derek and Dan discuss a fascinating new study looking at whether making the heart beat fast can cause anxiety-related behaviors. Hsueh et al., Cardiogenic control of affective behavioral state, Nature, March 2023 (https://www.nature.com/articles/s41586-023-05748-8)The information presented here is not medical advice. Consult your physician for any questions regarding your personal health.

Follow along while you listen to this show!   Just head over to nclexbook.com to get our Free eBook -  NCLEX Flash Notes, with 77- MUST KNOW NCLEX nursing topics . . . and as a bonus, you'll receive 16 full-color nursing cheatsheet.   www.nclexbook.com Cardiogenic Shock Flash Notes - The Best Way to Prep for NCLEX  Cardiogenic Shock is complete pump failure (heart) causing loss of oxygenated blood flow to the body. Master questions on Cardiogenic Shock with this clear and concise content that will help you conquer the NCLEX exam. www.nclexbook.com  

Interview with Robert W. Yeh, MD, MSc, author of Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic Shock, and David J. Cohen, MD, MSc, and Manesh R. Patel, MD, authors of Evidence Generation for Novel Cardiovascular Devices—Putting the Horse Back in Front of the Cart. Hosted by Ajay J. Kirtane, MD, SM. Related Content: Comparative Effectiveness of Percutaneous Microaxial Left Ventricular Assist Device vs Intra-Aortic Balloon Pump or No Mechanical Circulatory Support in Patients With Cardiogenic Shock Evidence Generation for Novel Cardiovascular Devices—Putting the Horse Back in Front of the Cart

Dr. Alin Gragossian talks about her experience with a health issue that interrupted her graduate medical education. She developed cardiogenic shock, was in the ICU, received a heart transplant and still managed to finish her emergency medicine residency and critical care fellowship! [00:00:23] Interrupted Medical Training.  [00:05:33] Cardiogenic shock and resuscitation.  [00:06:41] Severe heart failure.  [00:12:44] Heart transplant urgency.  [00:16:04] Heart transplant candidacy.  [00:20:36] Facing mortality before surgery.  [00:23:44] Phrases that helped.  [00:25:36] Caregivers and support people.  [00:28:13] Patient privacy in hospitals.  [00:31:39] Patient support in transplant.  [00:34:39] Heart transplant support group.  [00:37:07] Meeting a hero.  [00:41:35] Power of social media.  [00:43:29] Transplant patient as a resident. Many thanks to Doc2Doc Lending for supporting the show. If you're needing a doctor loan expert to help guide you on your financial journey, this company comes highly recommended by our audience! Did ya know…  You can also be a guest on our show? Please email me at brad@physiciansguidetodoctoring.com to connect.  Socials: @physiciansguidetodoctoring on FB  @physicianguidetodoctoring on YouTube

First of all, I apologize for the bad audio. This episode was lost until my buddy Haney Mallemat (@criticalcarenow) saved it. Aortic pulsatility index (API) is a hemodynamic measurement being studied to predict clinical outcomes in heart failure & cardiogenic shock. Show Notes: https://eddyjoemd.com/aortic-pulsatility-index/ TrueLearn Link: ⁠⁠https://truelearn.referralrock.com/l/EDDYJOEMD25/⁠⁠ Discount code: EDDYJOEMD25 Although great care has been taken to ensure that the information in this podcast are accurate, eddyjoe, LLC shall not be held responsible or in any way liable for the continued accuracy of the information, or for any errors, omissions or inaccuracies, or for any consequences arising therefrom.  My website: ⁠⁠www.eddyjoemd.com⁠⁠  Instagram: ⁠⁠www.instagram.com/eddyjoemd⁠⁠  Twitter: ⁠⁠www.twitter.com/eddyjoemd⁠⁠ Facebook: ⁠⁠www.facebook.com/eddyjoemd⁠⁠  Podcast: ⁠⁠https://anchor.fm/eddyjoemd⁠ --- Support this podcast: https://podcasters.spotify.com/pod/show/eddyjoemd/support

Hypotensive patient? Just reflexively give 30 cmL/kg, trend lactates, and broad spec antibiotics right? NOPE. Turns out, the heart could really care less. In fact, it might just decide to kill the patient if you do that. Let's talk about a lesser common cause of shock. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. Cite this podcast as: Briggs, Blake; Husain, Iltifat. Episode 174. Cardiogenic Shock. April 30th, 2023. https://www.emboardbombs.com/podcasts/174-cardiogenic-shock-the-heart-doesnt-care-about-your-sepsis-protocol. Accessed [date]

You're quietly sitting behind the drape and all of a sudden you see significant dysrhythmias on the ECG during an operation. Now what? In this episode Jeremy and Sass review a case of Cardiogenic Shock and go over the crisis checklist for this critical event. They also examine current diagnostic strategies and potential differential diagnoses. Here are some of the things you'll learn on this show: Thinking about the cardiovascular system in three separate parts (2:18) Here's the case we're facing on today's episode. (3:19) What are the initial thoughts on this overall picture? (4:33) What are the goals for managing this patient? (7:13) What happens if you see ST changes interoperatively? (9:48) Signs, symptoms and diagnostic criteria of cardiogenic shock. (12:13) What is prescribed? (19:50) The primary goal for this type of patient is to get them to the Cath lab. (24:12) Here's a question to test your knowledge. (25:03)   About our hosts: https://kpatprogram.org/about-the-school/faculty.html  Visit us online: http://beyondthemaskpodcast.com  Get the CE certificate here: https://beyondthemaskpodcast.com/wp-content/uploads/2020/04/Beyond-the-Mask-CE-Cert-FILLABLE.pdf

Evaluation of patients with Cardiogenic Shock. Why do we need a swan, introduction to CPO, PAPi and survival rates in these critically ill patients Show Notes: https://eddyjoemd.com/cardiogenic-shock-mcs/ TrueLearn Link: https://truelearn.referralrock.com/l/EDDYJOEMD25/Discount code: EDDYJOEMD25 --- Support this podcast: https://anchor.fm/eddyjoemd/support