15 results
DETROIT CARDIOGENIC SHOCK INITIATIVE ALGORITHM

INCLUSION CRITERIA
Acute Myocardial Infarction
 Ischemic Symptoms
 EKG and/or biomarker evidence of AMI
Ischemic Symptoms  EKG ... evidence of AMI (STEMI ... or NSTEMI) Cardiogenic ... DCSI #Initiative #Management ... #Cardiology
Inpatient Cath Lab Indications
Cath Lab ASAP:
STEMI
NSTEMI:
1. Unstable/cardiogenic shock
2. Severe LV dysfunction or
3. Recurrent/persistent rest angina despite
Cath Lab ASAP: STEMI ... Unstable/cardiogenic ... shock 2. ... low (1-2) risk, +ECG ... catheterization #cardiology
Severe Heart Failure & Cardiogenic Shock - Management Checklist 
Evaluation 
 - EKG & echocardiography
Shock - Management ... Revascularization, treatment ... #CHF #Shock #Cardiogenic ... #HeartFailure #Cardiology ... #Management
Left Main Coronary Artery Thrombus seen on Angiography

“Mother of all coronary thrombi”.  55 year old
Anterior wall STEMI ... , in Cardiogenic ... shock, ECG predicted ... Patient was in shock ... CathLab #clinical #cardiology
Shock - Differential Diagnosis Framework
 - MAP <65. SBP <90, drop in SBP > 40
 -
High SVR: • Cardiogenic ... Treatment Goals ... ) UOP > 0.5 cc/kg ... criticalcare #algorithm #treatment ... #management
Myocarditis
Diagnosis 
• Endomyocardial biopsy (gold standard, rarely performed) 
• Clinical presentation 
• Cardiovascular MRI 
Clinical 
•
gallop • Abnormal ECG ... Elevated troponin • Cardiogenic ... shock, sudden cardiac ... death Management ... #Cardiology
Myocarditis 

5 Principles of
Myocarditis:
1. Build clinical suspicion
2. Decide on EMBx
3. Manage acute cardiac injury
4. Manage chronic
- Acute HF, Cardiogenic ... shock, Arrythmias ... Pericarditis, Tamponade EKG ... Low voltage Treatment ... Myocarditis #diagnosis #management
Shock - Diagnosis and Management Summary
 • Hypotension: SBP<90, SBP drop >40, MAP<65 (Normotension, HTN possible
and Management ... telemetry, 12-Lead EKG ... resuscitation • Cardiogenic ... #Diagnosis #Management ... #criticalcare #treatment
STEMI Equivalents on ECG
 • Conventional STEMI - Elevation of ST segment at (or 40-60 ms
STEMI Equivalents ... segment at (or 40-60 ms ... elevation in aVR • Posterior ... #EKG #diagnosis ... #differential #cardiology
Right Heart Catheterization - Pulmonary Artery Pressures and Calculations
PULMONARY VASCULAR RESISTANCE = (meanPAP-PCWP) / CO
 •
RV dysfunction. e.g ... • Advanced cardiogenic ... forward flow. e.g ... Ahmed Ghoneem, MD MSc ... catheter #diagnosis #cardiology