Cardiogenic Shock and Embolism - Cardiovascular Update

A Case Report of Mycoplasma pneumoniae-induced fulminant myocarditis in a 15-year-old male leading to cardiogenic shock and electrical storm

Frontiers in Cardiovascular Medicine

APRIL 16, 2024

We present a case of a 15-year-old male who developed fulminant myocarditis, cardiogenic shock, and cardiac electrical storm attributed to M. pneumoniae infection. Following comprehensive treatment and rehabilitation, he was discharged in stable condition.

Cardiogenic Shock

Cardiogenic Shock Embolism Aortic Stroke

Successful pharmaco-invasive approach using a lower alteplase dose and VA-ECMO support in high-risk pulmonary embolism: case report

Frontiers in Cardiovascular Medicine

JULY 21, 2024

Despite the elevated mortality rates associated with high-risk pulmonary embolism (PE), this condition remains understudied. Data regarding the effectiveness and safety of invasive therapies such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) in this patient population remains controversial.

Embolism

Embolism Cardiogenic Shock Pulmonary Cardiac Arrest

Case Report: Can preoperative implantation of veno-arterial extracorporeal membrane oxygenation lead to embolic events in infective endocarditis?

Frontiers in Cardiovascular Medicine

MARCH 27, 2024

Common embolism sites include the brain, spleen, kidneys, lungs, and intestines. Cardiogenic shock (CGS) is often more likely to occur after AHF has taken place. Patients with IE can experience simple CGS, septic shock, or a combination of the two.

Cardiogenic Shock

Cardiogenic Shock Embolism Heart Failure Thrombosis

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Need for a Cardiogenic Shock Team Collaborative—Promoting a Team?Based Model of Care to Improve Outcomes and Identify Best Practices

Journal of the American Heart Association

MARCH 8, 2024

Cardiogenic shock continues to carry a high mortality rate despite contemporary care, with no breakthrough therapies shown to improve survival over the past few decades. A slowly maturing evidence base has suggested that cardiogenic shock teams may improve patient outcomes.

Cardiogenic Shock

Cardiogenic Shock Best Practices Outcomes Education

Acute artery occlusion -- which one?

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock). In patients with narrow QRS ( not this patient), this pattern is highly suggestive of acute pulmonary embolism. Additionally, there is borderline right axis deviation. Both were wrong.

Cardiogenic Shock

Cardiogenic Shock Ultrasound Tachycardia Pulmonary

Gender disparities in patients undergoing extracorporeal cardiopulmonary resuscitation

Frontiers in Cardiovascular Medicine

JANUARY 15, 2024

The primary reason for CA differed significantly (female: coronary event 45%, pulmonary embolism 23%, cardiogenic shock 17%; male: coronary event 70%, primary arrhythmia 10%, cardiogenic shock 10%; p = 0.001).

Cardiogenic Shock

Cardiogenic Shock Cardiac Arrest BMI Coronary Artery Disease

Two patients with chest pain and RBBB: do either have occlusion MI?

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Smith comment: before reading anything else, this case screamed pulmonary embolism to me. CT chest showed left sided pulmonary embolism and a pulmonary infarct that had previously been mistaken for pneumonia. Instead, he was diagnosed with pneumonia — that turned out to be a left-sided pulmonary embolism that was initially missed.

Chest Pain

Chest Pain STEMI Pulmonary Embolism

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) Self-expanding Versus Balloon-expandable Transcatheter Aortic Valve Replacement in Patients with Small Aortic Annuli: Primary Outcomes from the Randomized Smart Trial Effect of Edetate Disodium Based Chelation Infusions on Cardiovascular Events in Post-MI Patients with Diabetes: The TACT2 Trial Long-term Beta-blocker Treatment (..)

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

A crashing patient with an abnormal ECG that you must recognize

Dr. Smith's ECG Blog

MARCH 12, 2018

Notice I did not say "pulmonary embolism," because any form of severe acute right heart strain may produce this ECG. Differences of Pulmonary Embolism T-waves from Wellens' T-waves: 1. When there is tachycardia, the patient is in cardiogenic shock with very poor LV function on bedside echo. What is the answer?

Chest Pain

Chest Pain Pulmonary Embolism Tachycardia

Are these Wellens' waves?

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

No definite evidence of RV hypertrophy (normal axis, no large R-wave in V1) Late transition typical of COPD (R/S = 1 in V5) No evidence of old MI (no QS-waves in V1-V3, as seen in the presenting ECG) Other similar cases of acute right heart strain See this case of asthma whose ECG mimics acute PE: Is it pulmonary embolism? Kosuge et al.

Chest Pain

Chest Pain Pulmonary Tachycardia Embolism

Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Assessment was severe sudden cardiogenic shock. Clinically — despite an initial 2-fold increased troponin, the normal bedside Echo was reassuring against OMI or pulmonary embolism. Clinically — the patient was felt to be in cardiogenic shock. They recorded an EC G: New ST Elevation. What is it?

Cardiac Arrest

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock

Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). Then, part of the thrombus embolized into the LCx causing an inferoposterolateral OMI. (As The ECG has a lot of artifact, and the amplitude is very small, making interpretation challenging.

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

Unresponsive and Acidotic: OMI? Acute, subacute, or reperfused? What is the rhythm? Why RV dysfunction? Can CT scan help?

Dr. Smith's ECG Blog

APRIL 6, 2025

It did not show pulmonary embolism or intra-abdominal pathology, but it did show this: See the dark area at the bottom of the image? Assessment : Cardiology thought this was cardiogenic shock from RV dysfunction. Smith Comment: the RV was very ischemic on the CT scan and dysfunctional on echo, and this does explain the shock.

Blood Pressure

Blood Pressure Cardiogenic Shock Ischemia Cardiac Arrest

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

Dr. Smith's ECG Blog

MARCH 25, 2025

And it is definitely possible that a more proximal LCx lesion ruptured and produced distal embolism. A 2017 trial named CULPRIT SHOCK found that in patients with cardiogenic shock, a strategy of culprit vessel PCI only was associated with better outcomes than immediate multivessel PCI.

Chest Pain

Chest Pain Ischemia Plaque Stents

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

Dr. Smith's ECG Blog

APRIL 9, 2025

LAD: type III-IV vessel with a proximal thrombotic or embolic occlusion (TIMI 0 flow). The patient was transported to cath lab accompanied by the resident, with BP 50/30 en route improved with a push dose of 100 mcg epi. She had no further episodes of VF. Angiogram: 2. The final angiographic result is very good.

Defibrillator

Defibrillator Cardiac Arrest Myocardial Infarction STEMI

A Case Report of Mycoplasma pneumoniae-induced fulminant myocarditis in a 15-year-old male leading to cardiogenic shock and electrical storm

Successful pharmaco-invasive approach using a lower alteplase dose and VA-ECMO support in high-risk pulmonary embolism: case report

Case Report: Can preoperative implantation of veno-arterial extracorporeal membrane oxygenation lead to embolic events in infective endocarditis?

Webinars

Need for a Cardiogenic Shock Team Collaborative—Promoting a Team?Based Model of Care to Improve Outcomes and Identify Best Practices

Acute artery occlusion -- which one?

Gender disparities in patients undergoing extracorporeal cardiopulmonary resuscitation

Two patients with chest pain and RBBB: do either have occlusion MI?

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

A crashing patient with an abnormal ECG that you must recognize

Are these Wellens' waves?

Extreme shock and cardiac arrest in COVID patient

Noisy, low amplitude ECG in a patient with chest pain

Unresponsive and Acidotic: OMI? Acute, subacute, or reperfused? What is the rhythm? Why RV dysfunction? Can CT scan help?

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

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