Cardiogenic Shock, Stent and Stents - Cardiovascular Update

National Cardiogenic Shock Initiative Study Results Show Significant Increase in Heart Attack Survival

DAIC

DECEMBER 14, 2023

Henry Ford Health's National Cardiogenic Shock Initiative research team. Cardiogenic shock is a critical condition in which the heart is unable to pump enough blood to sustain the body’s needs, depriving vital organs of blood supply. This can cause those organs to eventually stop functioning.

Cardiogenic Shock

Cardiogenic Shock Heart attacks Heart Attack Myocardial Infarction

A more-Comers populAtion trEated with an ultrathin struts polimer-free Sirolimus stent: an Italian post-maRketing study (the CAESAR registry)

Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

Introduction The use of contemporary drug-eluting stents (DES) has significantly improved outcomes of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). Patients with left main (LM) disease, cardiogenic shock (CS), or severely reduced left-ventricular ejection fraction (LVEF) were excluded.

Stents

Stents Stent Cardiogenic Shock Coronary Artery Disease

3 days of shoulder and chest pain, and now cardiogenic shock

Dr. Smith's ECG Blog

AUGUST 28, 2020

Now appears to be in cardiogenic shock." However, cardiogenic shock usually takes some time to develop, so it is probably subacute." Cardiogenic shock and ACS is an indication for the cath lab, even if you don't think there is OMI. I was texted these ECGs. Then SOB and nausea the next day.

Cardiogenic Shock

Cardiogenic Shock Chest Pain Ischemia Stenosis

Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

Frontiers in Cardiovascular Medicine

MARCH 10, 2024

1.77), cardiogenic shock (pooled RR 3.68, 95% CI 2.65–5.11), 5.11), repeat PCI or stent thrombosis (pooled RR 1.99, 95% CI 1.21–3.28), In subsequent analyses, admission hyperglycemia was associated with an increased risk of reinfarction (pooled RR 1.69, 95% CI 1.31–2.17), 2.17), heart failure (pooled RR 1.56, 95% CI: 1.37–1.77),

Myocardial Infarction

Myocardial Infarction Cardiogenic Shock Article Outcomes

Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution

The British Journal of Cardiology

APRIL 16, 2024

Intra-procedural data included access route, coronary anatomy, lesion complexity, number of stents deployed, door-to-balloon time for primary PCI, and any intra-procedural complications. and the average number of stents 2.6. The radial approach was used in 544/567 (95.94%), the average SYNTAX score was 34.8 ± 9.6,

Outcomes

Outcomes Cardiogenic Shock Angina STEMI

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. The notes now refer to the patient being in cardiogenic shock, on pressors. Am J Emerg Med. 2014;32:e5–e8. J Cardiol Cases.

Chest Pain

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction

A 50-something with Regular Wide Complex Tachycardia: What to do if electrical cardioversion does not work?

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Past medical history includes coronary stenting 17 years prior. If you take old people with a history of MI (he had a stent), that percentage goes far higher since there is scar tissue that acts as a nidus for the PVCs that initiate VT. He had concurrent sharp substernal chest pain that resolved, but palpitations continued.

Tachycardia

Tachycardia Cardiogenic Shock Angina Coronary Angiogram

How terrible can it be to fail to recognize OMI? To whom is OMI Obvious or Not Obvious?

Dr. Smith's ECG Blog

OCTOBER 8, 2024

She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD. A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. She was worked as a full code, and ROSC was achieved. Later the next day, she went into cardiac arrest again.

Cardiac Arrest

Cardiac Arrest Myocardial Infarction STEMI Cardiogenic Shock

ECG Blog #453 — Is this Wellens' Syndrome?

Ken Grauer, MD

OCTOBER 25, 2024

P.S.: Cardiac cath was performed — and showed a distal LA D "culprit" lesion that was successfully stented. Unfortunately — this patient died within 12 hours of obtaining this tracing from cardiogenic shock. The above said, this is not Wellens' Syndrome — because a large infarction has already occurred! (

Blog

Blog Chest Pain Cardiogenic Shock STEMI

LBBB: Using the (Smith) Modified Sgarbossa Criteria would have saved this man's life

Dr. Smith's ECG Blog

JUNE 11, 2021

So the RCA was stented. The patient continued to have chest pain after the RCA was reperfused, so the LAD was then stented. But by this time the patient went into cardiogenic shock and passed away.

Chest Pain

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock

A man with chest pain off and on for two days, and "No STEMI" at triage.

Dr. Smith's ECG Blog

JUNE 19, 2023

The patient is started on epinephrine infusion for cardiogenic shock and cardiology took the patient to the cath lab. Two stents were placed with resultant TIMI 3 flow. The Queen of Hearts sees it of course: Still none of these three ECGs meet STEMI criteria.

Chest Pain

Chest Pain STEMI Cardiogenic Shock Ischemia

Cardiac Arrest, Ventricular Fibrillation, Inferior and Right ventricular MI (RVMI) or "Pseudoanteroseptal MI"

Dr. Smith's ECG Blog

JULY 14, 2010

She arrived comatose and in cardiogenic shock and the following ECG was recorded. Pressors were required, and the patient was transported to the cath lab with a door to balloon time of 60 minutes, where a proximal dominant RCA occlusion was opened and stented. She was intubated.

Cardiac Arrest

Cardiac Arrest Cardiogenic Shock Chest Pain Defibrillator

Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

OCTOBER 8, 2023

The patient was referred immediately for cath which revealed RCA occlusion that was stented. The patient died of cardiogenic shock within 24 hours despite mechanical circulatory support. There is some down sloping ST-segment and T wave inversion in lead aVL. The findings are diagnostic of inferior and posterior wall OMI.

Ischemia

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest

A man in his 70s with chest pain

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He was taken to the cath lab where he was found to have acute total occlusion of his saphenous vein graft to his RCA, which was stented. He was in cardiogenic shock requiring an impella for several days after cath. No further troponins were measured.

Chest Pain

Chest Pain Cardiac Arrest Cardiogenic Shock Heart attacks

A man in his 70s with acute chest pain and paced rhythm.

Dr. Smith's ECG Blog

MAY 8, 2023

So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent. Queen of Hearts interpretation: Now the cardiologist considered it "STEMI"!

Chest Pain

Chest Pain Myocardial Infarction STEMI Pacemaker

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

OCTOBER 7, 2019

Why is the patient in shock? He was in profound cardiogenic shock. He was successfully stented. There is an obvious inferior STEMI, but what else? Besides the obvious inferior STEMI, there is across the precordial leads also, especially in V1. This STE is diagnostic of Right Ventricular STEMI (RV MI).

Bradycardia

Bradycardia Cardiogenic Shock STEMI Ischemia

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

Dr. Smith's ECG Blog

MAY 30, 2023

Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. However, raising the pulse to 60 is hardly "working" for a patient who needs a lot more cardiac output. Fortunately, the patient made it to the cath lab alive without pacing or intubation.

Chest Pain

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock

How does Acute Total Left Main Coronary occlusion present on the ECG?

Dr. Smith's ECG Blog

AUGUST 9, 2019

TIMI flow 0) is rare in the ED, as most either die before arrival or are recognized clinically due to cardiogenic shock. 67) Less than 3% of anterior STEMI has LM OMI, and most are recognized clinically due to cardiogenic shock. (68, Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease.

Myocardial Infarction

Myocardial Infarction Ischemia STEMI Cardiogenic Shock

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

distal stent patent. The patient went into cardiogenic shock and ultimately died of this MI. Repeat ECG shows modest ST elevation in I and aVL and depression in inferior leads." The cath lab was activated. Angiogram: LM 30% ostial. LAD 80% mid LCx occluded mid (acute infarct lesion) RCA 80% mid.

Myocardial Infarction

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. However we also noticed that the rhythm is rapid, regular, and narrow, with no P-waves, at a rate of approximately 200 bpm, and therefore not sinus rhythm in this patient in his 60s.

Ischemia

Ischemia Atrial Flutter Arrhythmia Tachycardia

The First 60 Minutes of a Heart Attack: The Golden Hour

Wellnest

JULY 19, 2023

A completely blocked artery is located, a wire is inserted through it, the clot is sucked, the narrowing is widened with a balloon, and then a stent (stainless steel wire mesh) is placed to maintain consistent flow. It’s essential for those at risk of coronary artery disease to be aware of the following symptoms.

Heart attacks

Heart attacks Heart Attack Blood Pressure Myocardial Infarction

Published Research

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Institutional Coronary Artery Bypass Case Volumes and Outcomes European Journal of Heart Failure October 2023 Makoto Mori Robotic Mitral Valve Repair for Degenerative Mitral Regurgitation The Annals of Thoracic Surgery August 2023 Carlos Diaz-Castrillion Volume-Failure to Rescue Relationship in Acute Type A Aortic Dissections: An Analysis of The Society (..)

Research

Research Coronary Artery Bypass Graft Aortic valve Congenital

Published Research

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Institutional Coronary Artery Bypass Case Volumes and Outcomes European Journal of Heart Failure October 2023 Makoto Mori 1 Robotic Mitral Valve Repair for Degenerative Mitral Regurgitation The Annals of Thoracic Surgery August 2023 Carlos Diaz-Castrillion 2 Volume-Failure to Rescue Relationship in Acute Type A Aortic Dissections: An Analysis of The (..)

Research

Research Coronary Artery Bypass Graft Aortic valve Congenital

National Cardiogenic Shock Initiative Study Results Show Significant Increase in Heart Attack Survival

A more-Comers populAtion trEated with an ultrathin struts polimer-free Sirolimus stent: an Italian post-maRketing study (the CAESAR registry)

3 days of shoulder and chest pain, and now cardiogenic shock

Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

A 50-something with Regular Wide Complex Tachycardia: What to do if electrical cardioversion does not work?

How terrible can it be to fail to recognize OMI? To whom is OMI Obvious or Not Obvious?

ECG Blog #453 — Is this Wellens' Syndrome?

LBBB: Using the (Smith) Modified Sgarbossa Criteria would have saved this man's life

A man with chest pain off and on for two days, and "No STEMI" at triage.

Cardiac Arrest, Ventricular Fibrillation, Inferior and Right ventricular MI (RVMI) or "Pseudoanteroseptal MI"

Should we activate the cath lab? A Quiz on 5 Cases.

A man in his 70s with chest pain

A man in his 70s with acute chest pain and paced rhythm.

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

How does Acute Total Left Main Coronary occlusion present on the ECG?

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

The First 60 Minutes of a Heart Attack: The Golden Hour

Published Research

Published Research

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