Myocarditis
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
Fulminant myocarditis is an uncommon syndrome characterized by sudden and severe diffuse cardiac inflammation often leading to death resulting in cardiogenic shock, ventricular arrhythmias, or multi- organ system failure. Historically, FM was almost exclusively diagnosed at autopsy. However, in the present day, with our ability to fully support a patient's circulation, the early recognition of FM, institution of circulatory support, and maintenance of end-organ function (especially avoiding hypoxic brain damage) can result in favourable outcomes in what was previously almost universally fatal. Fulminant myocarditis clinically has a limited differential diagnosis including giant cell myocarditis, necrotizing eosinophilic myocarditis, lymphocytic myocarditis and acute myocardial infarction. It can also be difficult to distinguish from other common causes of cardiogenic shock such as acute coronary syndromes or stress-induced cardiomyopathy. It has been largely attributed to more aggressive host inflammatory responses. The broader concept is of “inflammatory cardiomyopathy” as a spectrum rather than a distinct histopathologic conditions. EMB should always be done in heart failure that is rapidly progressing when there is a high suspicion that the cause is myocarditis. Most experienced centres adopt this approach to establish the diagnosis of widespread inflammation with EMB and leads to advanced support strategies.
Shock
Lauren A. Plante in Expecting Trouble, 2018
Cardiogenic shock is defined as anaerobic metabolism precipitated by cardiac pump failure. When the obstetric practitioner is faced with cardiac failure, it is important to categorize the reason for pump failure. Cardiac pump failure can be secondary to cardiomyopathic failure, arrhythmogenic failure (tachyarrhythmia and bradyarrhythmia), and valvular failure (i.e., critical aortic stenosis and mitral valve stenosis) (36). Although pregnant women can experience all classifications of failure, the most common associated with obstetrics will likely be cardiomyopathic failure (i.e., peripartum cardiomyopathy and myocardial infarction). Women presenting in suspected cardiogenic shock should have baseline laboratory investigations, thyroid studies, biochemical cardiac markers, electrocardiography, and echocardiogram to help differentiate etiology of failure.
Acute Coronary Syndromes
Karim Ratib, Gurbir Bhatia, Neal Uren, James Nolan in Emergency Cardiology, 2010
The factors associated with an increased risk of developing cardiogenic shock are: extensive Q-wave anterior MI, STEMI associated with left bundle branch block or failure of reperfusionMI occurring in patients with previous infarction or CABGincreasing age or female sexhypertensiondiabetes.
COVID-19 and cardiovascular disease: manifestations, pathophysiology, vaccination, and long-term implication
Published in Current Medical Research and Opinion, 2022
Adel Abdel Moneim, Marwa A. Radwan, Ahmed I. Yousef
Heart failure in COVID-19 is mediated by various mechanisms such as virus-induced infiltration of inflammatory cells that could deteriorate cardiac function. Pro-inflammatory cytokines (i.e. tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6) can cause endothelial injury. When coupled with micro-thrombosis, these can also damage the endocardium and cause necrosis and death of the myocardium. Furthermore, ARDS and respiratory failure can induce heart failure as a result of severe hypoxia (Figure 1)59. Of 901 admissions to an ICU due to COVID-19, 80 (8.9%) had acute heart failure, including 18 (2.0%) with classic cardiogenic shock and 37 (4.1%) with vasodilatory cardiogenic shock32. Cardiogenic shock can be either mainly cardiac in the cause or have a mixed pulmonary and cardiac pathogenesis60 (Figure 1, Table 1).
Echocardiography in a critical care unit: a contemporary review
Published in Expert Review of Cardiovascular Therapy, 2022
Muhammad Mohsin, Muhammad Umar Farooq, Waheed Akhtar, Waqar Mustafa, Tanzeel Ur Rehman, Jahanzeb Malik, Taimoor Zahid
Pathophysiology of cardiogenic shock is caused by depressed myocardial function causing decreased cardiac output, circulatory collapse, end-organ hypoperfusion, and hypoxia. It is defined as systolic blood pressure of <90 mmHg for ≥ 30 minutes or use of mechanical and/or pharmacological support to maintain a systolic blood pressure of ≥ 90 mmHg, in addition to the clinical evidence of end-organ hypoperfusion because of LV or RV dysfunction. The majority of the patients admitted with cardiogenic shock in CCUs have an AMI. LV systolic dysfunction is invariably present with cardiogenic shock, which is easily demonstrated during echocardiography. A qualitative assessment of the LV can be made on a visual 2D assessment of the cardiac chambers in PLAX or PSAX view. Expert readers of echocardiography can accurately diagnose LV function by ‘eyeballing’ fairly accurately. For other readers, a quantitative assessment of LV function can be performed for true estimation of LV function by a modified Simpson’s biplane method.
Outcomes of surgical Impella placement in acute cardiogenic shock
Published in Baylor University Medical Center Proceedings, 2023
Timothy J. George, Jenelle Sheasby, J. Michael DiMaio, Nitin Kabra, David A. Rawitscher, Aasim Afzal
Patient demographics, comorbidities, laboratory values, measures of acuity, operative data, and outcomes were extracted from the electronic medical record. Patients were broadly classified into three etiologies for cardiogenic shock. The first etiology was AMI complicated by shock. These patients had clinical, angiographic, and laboratory-confirmed evidence of myocardial injury in the setting of compromised end-organ perfusion. The second was acute on chronic heart failure. These patients had a history of heart failure with reduced ejection fraction who presented with a combination of heart failure exacerbation and compromised end-organ perfusion. The third was postcardiotomy shock. This group comprised patients with compromised end-organ perfusion within 48 hours of cardiac surgery. There was one patient who had refractory ventricular tachycardia who was not easily grouped into any of the three categories.
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