Muscular organ responsible for pumping blood through the circulatory system in most animals
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Every CRNA school interview panel asks about shock. Most applicants can name the four types. What separates the answers that land is mechanism — Frank-Starling in hypovolemic, the afterload trap in cardiogenic, iNOS-driven nitric oxide collapse in distributive, RV dilation and septal shift in obstructive. This episode covers all four shock states at the cellular level: hemodynamic profiles, bedside clues, and the exact language to use when a program asks you to walk through shock in an interview. We have a full shock states lesson inside The CRNA Club learning library — hemodynamic profiles for every shock type, built for CCRN prep and CRNA interview practice. Start your free seven-day trial. FREE RESOURCES TO HELP YOU ON YOUR CRNA JOURNEY: Transcript Analyzer - Find out if your GPA is competitive for CRNA school 9-Step Application Checklist - Every step you need to apply to CRNA school, in order CRNA School Database - Search and compare 140+ CRNA programs Certification Planner - Your personalized CCRN study schedule Timeline Generator - Build your personalized application timeline Try The CRNA Club FREE for 7 days - The only tool personalized to YOUR CRNA school journey CHAPTERS: [00:00] Cold open: warm post-op patient, ambiguous shock type [01:30] Welcome and shared framework: shock as inadequate tissue perfusion [02:30] Tank, pump, pipes, obstruction overview [03:00] Hypovolemic shock: Frank-Starling, sympathetic compensation, why pressors alone fail [06:00] Mid-episode: learning library shock lesson [07:00] Cardiogenic shock: calcium handling failure, the afterload trap, inotrope rationale [10:00] Distributive shock: iNOS, nitric oxide, why norepinephrine targets the right receptor [13:00] Obstructive shock: PE anatomy, tension pneumo, tamponade — and Beck's triad caveat [15:00] How to answer the shock question in your CRNA interview [16:30] Three clinical takeaways and cold open callback Follow us on Instagram: @thecrnaclub More resources at THECRNACLUB.COM
Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Comparison of Microcirculation in Chronic Heart Failure, Cardiogenic Shock, LVAD, and Heart Transplantation.
Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Characteristics, Management, and Outcomes of Diabetes Subtypes in Patients With Cardiogenic Shock: A Nationwide Analysis.
LBCT: Interleukin-6 Inhibition in Acute Myocardial Infarction at Risk of Cardiogenic Shock: A Randomized Controlled Trial
The mortality rate of cardiogenic shock is around 50%, so prevention and rapid treatment are critical to ensure improved patient outcomes. Guest Amy Sheppard, BSN, MS, describes the stages of shock, what leads to cardiogenic shock, treatments, and communication strategies for patients and families.References and Related ResourcesSCAI Shock PyramidPCNA Heart Failure Pocket GuideSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
In this ACC.26 interview, Dr. Tharshini Ramalingam speaks with Dr. Eric Yang of UCLA about a rare and sobering case presented at ACC.26 of immune checkpoint inhibitor myocarditis with predominant right ventricular failure and cardiogenic shock. Their discussion highlights the diagnostic complexity of atypical myocarditis, the importance of recognizing unusual presentations, and the need for better screening, imaging, and phenotyping strategies in cardio-oncology care and research.
A thoughtful and important JACC State-of-the-Art Review reframes cardiogenic shock not as a single ICU event, but as a longitudinal survivorship journey. The article highlights recovery, remission, native heart survival, PICS, HF GDMT optimization, and the need for structured multidisciplinary postshock clinics focused on function, cognition, quality of life, and recurrent risk after discharge. A timely call to move from rescue alone to rescue plus recovery.
We've been teasing this one for a while and now it's finally ready! This week we've released our first LIVE podcast from Chest 2025 where we cover cases in cardiogenic shock with our amazing panel of incredible clinicians. Nick & Cyrus moderate a discussion using a choose-your-own-adventure format, leveraging the expertise of our panelists in an hour long, fun-filled and practical discussion where we put some of our earlier CCT content to practice in some real world cases. Check out the YouTube channel or the website if you want to follow along with the slides. Please let us know how you like this!! Hosted on Acast. See acast.com/privacy for more information.
Mirza Umair Khalid, MD, Social Media Editor for JACC: Cardiovascular Interventions, and Rikke Sørensen, MD, PhD, discuss a recently published original research paper from DanGer Shock substudy analyzing the bleeding events in patients with infarct related cardiogenic shock.
In this episode of Saving Lives: Critical Care Conversations, we discuss new evidence from the University of Pennsylvania that challenges how we time inotropic therapy in acute decompensated heart failure–related cardiogenic shock.This retrospective cohort study found that patients who received inotropes within eight hours of meeting SCAI stage C criteria had a 28-day mortality of 17%, compared to 33% in those who received them later. Early inotrope use was also associated with less vasopressor dependence and quicker access to echocardiography and hemodynamic monitoring.We'll explore what this means for emergency and critical care practice—how recognizing hypoperfusion early, even in normotensive patients, may improve survival. We'll also touch on the role of SCAI and SHARC criteria in timely shock identification and management.Because in cardiogenic shock, the difference between early and delayed therapy might be the difference between life and death.The Vasopressor & Inotrope HandbookAmazon: https://amzn.to/47qJZe1 (Affiliate Link)My Store: https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook (Use "podcast" to save 10%)Citation: Greenwood JC, Ratnayake C, Shabbir M, Opitz S, Jang DH, Choi WJ, Panebianco NL, Shofer FS, Augoustides JGT, Bakker J, Wald JW, Abella BS. Timing of inotropic support is associated with mortality in patients with acute decompensated heart failure-associated cardiogenic shock. Intensive Care Med Exp. 2025 Oct 31;13(1):111. doi: 10.1186/s40635-025-00806-z. PMID: 41174190; PMCID: PMC12579036.
Mirza Umair Khalid, MD, social media editor of JACC: Cardiovascular Interventions, and Jasmine Marquard discuss a recently published study examining PCI in multivessel disease during infarct-related cardiogenic shock.
On this episode of JHLT: The Podcast, the Digital Media Editors invite co-lead author Nir Uriel, MD, Director of Advanced Heart Failure and Cardiac Transplantation at New York Presbyterian Hospital and Professor of Medicine at Columbia University. Dr. Uriel joins to discuss the work of the Cardiogenic Shock Working Group (CSWG) and their recent paper, “Outcomes of patients supported on Impella 5.5 for more than 14 days: A Cardiogenic Shock Working Group registry analysis.” The discussion explores: Why patients on longer duration of MCS had better survival but maintained similar rates of serious adverse events (SAEs) Why the study might show fewer SAEs than the literature historically shows How temporary MCS devices are selected in clinical settings in patients with cardiogenic shock The ongoing and upcoming activities of CSWG For the latest studies from JHLT, visit www.jhltonline.org/current, or, if you're an ISHLT member, access your Journal membership at www.ishlt.org/jhlt. Don't already get the Journal and want to read along? Join the International Society of Heart and Lung Transplantation at www.ishlt.org for a free subscription, or subscribe today at www.jhltonline.org.
In this episode, we review the high-yield topic Cardiogenic Shock from the Cardiovascular section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
DAPT-SHOCK-AMI Trial: Cangrelor in Cardiogenic Shock
Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Cardiogenic Shock With Acute Myocardial Infarction Among Older Adults in the United States.
Why would a healthy newborn suddenly stop eating and start vomiting? When a fussy baby comes into the ER, it's easy to assume it's nothing urgent — like colic or gas. But in today's case, there were small signs that pointed to something more.This episode unpacks the high-risk condition and treatment of neonatal cardiogenic shock with Natalie Pleiman, pediatric nurse and clinical coach. From the early (often misleading) signs to critical assessments, you'll learn what makes cardiogenic shock different in neonates (specifically ductal dependent lesions), what to look for in patient labs, and how to manage the risks of treatment.Tune in for insights that will help you on your next pediatric cardiac emergency!Topics discussed in this episode:Neonatal triage: initial assessment and red flagsPhysical exam and early diagnosticsDifferences in neonatal anatomy and physiologyPreductal vs. postductal vitalsSigns of coarctation of the aortaAssessing for sepsis vs. cardiogenic shockThe dangers of fluid bolusesHow to effectively administer prostaglandinsThe risk and process of neonatal intubationPathophysiology of coarctation of the aortaICU stabilization to optimize cardiac functionKey signs of congenital heart conditionsNatalie's framework for understanding congenital heart defectsConnect with Natalie:https://www.instagram.com/chatwithnat_rn/Listen to Chat with Nurse Nat on Spotify:https://open.spotify.com/show/7Jh2qe44KipudVKkdXFwWHListen to Chat with Nurse Nat on Apple Podcasts:https://podcasts.apple.com/us/podcast/chat-with-nurse-nat/id1815541418Mentioned in this episode:Listen to the In The Heart of Care Podcasthttps://link.cohostpodcasting.com/6598429e-e927-45b0-9b57-7dd34a09d803?d=seASyqjs7CONNECT
Dr. Shannon Fernando is an intensivist at Lakeridge Health and a prolific researcher with over 150 publications. Known for his work in outcomes-based research across critical care, he joins us to discuss long-term outcomes after cardiogenic shock.About the Episode:This episode is part of our cardiovascular critical care series and explores what happens after the ICU for patients who survive cardiogenic shock. We unpack quality of life, functional outcomes, mental health, and the hidden burdens on both patients and caregivers. Dr. Fernando provides key data insights from his large cohort studies and shares reflections from ICU follow-up clinics. We also dive into the challenges of prognostication and how to communicate realistic expectations to families.Topics CoveredDefining Long-Term Outcomes:Beyond survival: functional independence, mental health, cognition, and system resource use.Key Findings from Ontario Cohort42% of cardiogenic shock survivors require increased levels of care15% die within a year post-dischargeModest impact of revascularization or mechanical support on long-term outcomesMorbidity and Quality of LifeLoss of independence and inability to return to workHigh incidence of PTSD, depression, and caregiver burdenDelayed functional recovery and unmet expectationsPrognostic Factors and Predictive MarkersFrailty as a key indicatorPre-existing mental health as a predictor of post-ICU mental health outcomesIn-hospital arrest characteristics: rhythm, downtime, comorbiditiesICU Follow-Up ClinicsValue in knowledge translation and emotional supportReal-world insights on functional recovery and patient satisfactionCommon patient sentiment: gratitude mixed with traumaCommunication with FamiliesAvoiding value impositionEmphasizing trajectory over fixed timelinesBalancing hope with realismRethinking Endpoints in ResearchLimitations of 28-day mortalityNeed for patient-centered, long-term functional outcomesTrajectory-based data over snapshot metricsKnowledge Translation as the InterventionEquipping clinicians and patients with realistic expectationsNormalizing psychological responsesShaping future research directions around lived experience
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Prof. Jacob Eifer Moller from Odense, Denmark. They discuss his review paper on mechanical circulatory support and some of the supporting guidelines and papers in this area. If you enjoy the show, please leave us a positive review wherever you get your podcasts. It helps us to reach more people - thanks! Link to published paper: https://heart.bmj.com/content/early/2025/01/15/heartjnl-2024-324883
In this episode, recorded live at CCCF 2024, we sit down with Dr. Emilie Belley-Côté, a cardiac intensivist, researcher, and clinical trialist from McMaster University, to unpack cardiogenic shock: the SCAI classification.Whether you're in the ED, cath lab, or ICU, the SCAI (Society for Cardiovascular Angiography and Interventions) stages offer a common language to describe the severity of cardiogenic shock, guide escalation of care, and improve outcomes through structured assessment.Dr. Belley-Côté walks us through:The five SCAI stages (A through E): what they mean and how they're used.How this classification system improves communication between specialties.The importance of recognizing patients in pre-shock (Stage B) before they deteriorate.Real-world application: how SCAI staging intersects with clinical signs, biomarkers, and hemodynamic monitoring.Where the SCAI classification fits in research, including trials evaluating mechanical circulatory support and advanced heart failure therapies.With Dr. Belley-Côté's clear explanations and insights from the front lines of cardiac critical care, this episode is essential listening for anyone managing unstable cardiac patients.
In this episode, we analyze a June 2025 study from the Journal of Intensive Care, which shows that lower hemoglobin levels at admission are strongly associated with worse outcomes in cardiogenic shock. We dive into the data from the FRENSHOCK registry, uncover key subgroup findings, and discuss implications for transfusion strategies. Could this shift how we manage anemia in shock? Tune in and find out.The Vasopressor & Inotrope HandbookI 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: Cherbi M, Levy B, Merdji H, Puymirat E, Bonnefoy E, Vardon F, Elbaz M, Morel O, Leurent G, Lamblin N, Gerbaud E, Gautier P, Roubille F, Delmas C. Hemoglobin in cardiogenic shock: the lower, the poorer survival. J Intensive Care. 2025 Jun 23;13(1):36. doi: 10.1186/s40560-025-00805-y. PMID: 40551259.
Management of Cardiogenic Shock 2025
Commentary by Dr. Jian'an Wang.
JACC's June 10 issue, focusing on the ACS guideline, features a series of videos with unique perspectives. In this video, JACC: Executive Associate Editor Karthik Murugiah, MBBS, MHS, FACC, introduces his paper discussing the guideline's reliance on four landmark RCTs in AMI-CS. Several sweeping changes in recommendations for MCS use have been codified that should influence practice and improve care for these high-risk patients. While IABP use is expected to decrease, use of mAFP is likely to increase but should be judicious, with caution against overgeneralizing given the narrow selection criteria of DanGer Shock. Evaluating real-world practice patterns and outcomes of patients with AMI-CS based on these recommendations will be paramount.
Commentary by Dr. Jian'an Wang.
Commentary by Dr. Kitae Kim.
Are you equipped to handle cardiogenic shock? In this episode, you'll gain insights from an expert on the frontlines about the complexities of caring for these critical patients and how you can excel in providing world-class critical care transport.Shane Turner sits down with Dr. Adam Gottula, an emergency physician and critical care intensivist from Methodist Hospital in San Antonio, Texas. They discuss the management of cardiogenic shock in transport settings, the crucial role of a multidisciplinary approach, and the latest strategies for improving patient outcomes.Dr. Gottula shares the importance of cognitive checklists, standardized patient classification, and the life-saving role of the Impella device during transport. Plus, essential practices for optimizing outcomes in patients with Impella support during cardiac arrest, including the critical steps of prompt CPR and correct device positioning.Shane Turner, RN, CFRN, NRP, FP-C, CMTE, Chattanooga, TNAdam Gottula, M.D., San Antonio, Texas
In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.
In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.
In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.
In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.
In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.
In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.
In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.
In this episode, Dr. Valentin Fuster dives into the complex and high-stakes world of cardiogenic shock, spotlighting new clinical trials, expert consensus guidance, and cutting-edge insights from machine learning. From evaluating the impact of intra-aortic balloon pumps to rethinking mechanical support strategies, the episode delivers a powerful update on one of cardiology's most urgent challenges.
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.
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.
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...
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.
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