Cardiogenic Shock and Ultrasound - Cardiovascular Update

Ep 164 Cardiogenic Shock Simplified

ECG Cases

JANUARY 4, 2022

What is the preferred order of vasopressors and ionotropes in the management of cardiogenic shock? How can we best pick up occult cardiogenic shock before it floured shock kicks in? The post Ep 164 Cardiogenic Shock Simplified appeared first on Emergency Medicine Cases.

Cardiogenic Shock

Cardiogenic Shock Heart Failure Aortic Stenosis

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). Answer : Bedside ultrasound! Smith : RV infarct may also have this appearance on ultrasound. So hypoxia without B lines on lung ultrasound strongly weights toward PE. Both were wrong.

Cardiogenic Shock

Cardiogenic Shock Ultrasound Tachycardia Pulmonary

Case Report: Massive intrapericardial hematoma following acupuncture therapy

Frontiers in Cardiovascular Medicine

OCTOBER 14, 2024

This paper reports a case of an elderly female patient who experienced severe chest pain and syncope during acupuncture therapy, subsequently diagnosed with traumatic hemopericardium and acute cardiac tamponade, complicated by cardiogenic shock. Under ultrasound guidance, pericardial puncture and drainage were successfully performed.

Cardiogenic Shock

Cardiogenic Shock Chest Pain Ultrasound Hemorrhage

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Tachycardia must make you doubt an ACS or STEMI diagnosis; put it all in clinical context

Dr. Smith's ECG Blog

OCTOBER 26, 2010

ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. Then ACS (STEMI) might be primary; this might be cardiogenic shock. Even if this ECG is the first thing one sees (as it was for me), one should stop and think: "This is an unusual STEMI." Are the lungs clear? Is the patient cool and pale?

STEMI

STEMI Cardiogenic Shock Tachycardia Aneurysm

Interplay between mitochondrial dysfunction and lysosomal storage: challenges in genetic metabolic muscle diseases with a focus on infantile onset Pompe disease

Frontiers in Cardiovascular Medicine

FEBRUARY 19, 2024

Background Pompe disease (PD) is a rare, progressive autosomal recessive lysosomal storage disorder that directly impacts mitochondrial function, leading to structural abnormalities and potentially culminating in heart failure or cardiogenic shock.

Cardiogenic Shock

Cardiogenic Shock Quality of Life Heart Failure Laboratory

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

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

Ischemia

Ischemia Cardiogenic Shock Aortic Stenosis

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

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

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. RVMI explains part of the shock. If it did not do so, norepinephrine would be indicated to maintain systolic BP As for the escape rhythm: It is narrow complex, and therefore it is in the His bundle or above (not below the His bundle).

Chest Pain

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock

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

Dr. Smith's ECG Blog

JUNE 11, 2021

Thirty minutes later the first Troponin I came back elevated at 650 ng/L (normal <26), and bedside ultrasound found anteroseptal akinesia. But by this time the patient went into cardiogenic shock and passed away. But it didn’t meet traditional Sgarbossa criteria so the cath lab was not activated.

Chest Pain

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock

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

Dr. Smith's ECG Blog

OCTOBER 17, 2024

I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. As for the ECG, it could represent OMI, but RBBB is also a clue that it may be PE. There is sinus tachycardia at ~100/minute.

Chest Pain

Chest Pain STEMI Pulmonary Embolism

Chest Pain and Inferior ST Elevation.

Dr. Smith's ECG Blog

JUNE 17, 2018

I have always said that tachycardia should argue against acute MI unless there is cardiogenic shock or 2 simultaneous pathologies. Sinus tachycardia, which exaggerates ST segments and implies that there is another pathology. We showed this in a recent analysis of UTROPIA data (see abstract below).

Chest Pain

Chest Pain Pericarditis Tachycardia Myocardial Infarction

Guess the culprit with ST Elevation in posterior leads

Dr. Smith's ECG Blog

APRIL 24, 2020

Just prior to transport, the patient became confused and agitated and, although blood pressure and pulse were OK, I was worried about cardiogenic shock. Diagnosis : Posterior MI, right? We intubated him. Cath lab The BP was 70/40 on arrival to the cath lab and received a balloon pump and norepinephrine.

Ischemia

Ischemia Chest Pain Stenosis STEMI

A young peripartum woman with Chest Pain

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock. Type 2 is more difficult to appreciate on angiography than type 1. Lobo et al. where more than 3/4 of cases were NSTEMI).

Chest Pain

Chest Pain SCAD STEMI Cardiogenic Shock

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., A emergent cardiology consult can be helpful for equivocal cases. Left main? 3-vessel disease? Knotts et al.

Ischemia

Ischemia STEMI Stenosis Chest Pain

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

Shocked x 2 without effect. Pads were placed with ultrasound guidance, so they were in the correct position. No adenosine was given (if you believe it is SVT, this is worth a try). However, this is not SVT. If it is VT, adenosine is safe but not effective. What to do now? If you believe it is SVT, then try adenosine. Patient intubated.

Tachycardia

Tachycardia Cardiogenic Shock Angina Blog

What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. Another approach is sympathetic chain (stellate ganglion) blockade if you have the skills to do it: it requires some expertise and ultrasound guidance. RCA — 100% proximal occlussion.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves

Dr. Smith's ECG Blog

JULY 18, 2014

Case Continued 2 days later the patient became increasingly tachycardic, hypotensive, ashen, clammy (in cardiogenic shock) and had a new murmur. Rupture can be either free wall rupture (causing tamonade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock.

STEMI

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock

Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. Assessment was severe sudden cardiogenic shock. Clinically — the patient was felt to be in cardiogenic shock. This sinus tachycardia ( at ~130/minute ) — is consistent with the patient’s worsening clinical condition, with development of cardiogenic shock.

Cardiac Arrest

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock

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. They did not have an ultrasound on the ambulance (some local crews are starting to utilize POC limited US in our service areas). There is an obvious inferior STEMI, but what else? This STE is diagnostic of Right Ventricular STEMI (RV MI).

Bradycardia

Bradycardia STEMI Cardiogenic Shock Ischemia

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). A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW. We can see enough to make out that the rhythm is sinus tachycardia.

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

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

Dr. Smith's ECG Blog

APRIL 9, 2025

On arrival in the ED, a bedside ultrasound showed poor LV function (as predicted by the Queen of Hearts) with diffuse B-lines. I don't know what the device algorithm interpretation stated. I am not certain if there was a prehospital cath lab activation, but there should be. Initial BP was 120/96, HR 102, SpO2 98%.

Defibrillator

Defibrillator Cardiac Arrest Myocardial Infarction STEMI

Pulmonary edema, with tachycardia and OMI on the ECG -- what is going on?

Dr. Smith's ECG Blog

MARCH 3, 2025

Whenever there is tachycardia, I am skeptical of OMI unless it has led to severely compromised ejection fracction with cardiogenic shock. I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Or I suspect that there is OMI simultaneous with another pathology.

Tachycardia

Tachycardia Pulmonary Chest Pain Stenosis

EM Quick Hits 28 Cardiogenic Shock, Radiation Dose in Pregnancy, PoCUS in Airway Management, VIPIT, Angiotensin II, Short-Term Steroid Safety

ECG Cases

MAY 4, 2021

The post EM Quick Hits 28 Cardiogenic Shock, Radiation Dose in Pregnancy, PoCUS in Airway Management, VIPIT, Angiotensin II, Short-Term Steroid Safety appeared first on Emergency Medicine Cases.

Cardiogenic Shock

Cardiogenic Shock COVID-19 Ultrasound

Ep 164 Cardiogenic Shock Simplified

Acute artery occlusion -- which one?

Case Report: Massive intrapericardial hematoma following acupuncture therapy

Webinars

Tachycardia must make you doubt an ACS or STEMI diagnosis; put it all in clinical context

Interplay between mitochondrial dysfunction and lysosomal storage: challenges in genetic metabolic muscle diseases with a focus on infantile onset Pompe disease

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

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

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

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

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

Chest Pain and Inferior ST Elevation.

Guess the culprit with ST Elevation in posterior leads

A young peripartum woman with Chest Pain

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

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

What are treatment options for this rhythm, when all else fails?

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves

Extreme shock and cardiac arrest in COVID patient

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

Noisy, low amplitude ECG in a patient with chest pain

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

Pulmonary edema, with tachycardia and OMI on the ECG -- what is going on?

EM Quick Hits 28 Cardiogenic Shock, Radiation Dose in Pregnancy, PoCUS in Airway Management, VIPIT, Angiotensin II, Short-Term Steroid Safety

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