Remove Cardiogenic Shock Remove Physiology Remove Pulmonary
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Advanced hemodynamics for prognostication in heart failure: the pursuit of the patient-specific tipping point

Frontiers in Cardiovascular Medicine

Methods Here, a mathematical and physiological framework to define the patient-specific tipping point of myocardial energetics is defined. A novel hemodynamic parameter known as the myocardial performance score (MPS), a marker of power and efficiency, is introduced that allows for the objective assessment of the physiological tipping point.

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Abstract 4143844: Multidisciplinary management of a pregnant patient with advanced systolic heart failure

Circulation

However, stabilization was expected to be temporary due to ongoing physiologic changes of pregnancy. After discharge, she was scheduled for a 2-week postpartum visit including echocardiogram, EKG, and NT-proBNP.Discussion:Given the patient's acute decompensation and fluid overload, medical optimization was essential prior to delivery.

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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

The patient was transported to the CCU for further medical optimization where a pulmonary artery catheter was placed. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. Fundamentally, cardiogenic shock is an issue of decreased cardiac output.

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A crashing patient with an abnormal ECG that you must recognize

Dr. Smith's ECG Blog

Notice I did not say "pulmonary embolism," because any form of severe acute right heart strain may produce this ECG. This includes, but is not limited to, PE, asthma/COPD exacerbation, hypoxic vasoconstriction from pneumonia, acute pulmonary hypertension exacerbation. Differences of Pulmonary Embolism T-waves from Wellens' T-waves: 1.

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Are these Wellens' waves?

Dr. Smith's ECG Blog

My answer: "This is classic for PE, but it can also be present in any hypoxia due pulmonary hypoxic vasoconstriction and resulting acute pulmonary hypertension and acute right heart strain. Tachycardia is unusual in ACS unless there is cardiogenic shock or a second simultaneous pathology. This is NOT Wellens.