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- Cardiogenic shock (20)
- Hemodynamics (4)
- Myocardial infarction (4)
- Impella (3)
- Mechanical circulatory support (3)
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- Percutaneous mechanical circulatory support (3)
- ECMO (2)
- Heart failure (2)
- Management (2)
- Vasopressors (2)
- ARDS (1)
- Amyloidosis (1)
- Aortic fistula (1)
- Aorto-SVC fistula (1)
- COVID-19 (1)
- Cardiac index (1)
- Cardiac output (1)
- Cardiointestinal syndrome (1)
- Cardioplegia (1)
- Chronic aortic dissection (1)
- Circulatory shock (1)
- Classification (1)
- Clinical trials (1)
- Coronary artery bypass graft (1)
- Coronary artery bypass grafting (1)
- Coronary flow (1)
- Coronavirus (1)
- Critical care (1)
- Cytokines (1)
- Diastolic dysfunction (1)
Articles 1 - 30 of 38
Full-Text Articles in Cardiology
Aorto-Superior Vena Cava Fistula Secondary To Ascending Aortic Dissection, Talal Al-Assil, Aiden Michael Van Loo, Bakri Kaakeh, Bashar Al Jayyousi, Rania Esteitie
Aorto-Superior Vena Cava Fistula Secondary To Ascending Aortic Dissection, Talal Al-Assil, Aiden Michael Van Loo, Bakri Kaakeh, Bashar Al Jayyousi, Rania Esteitie
Journal of Shock and Hemodynamics
Aortic fistulas are a rare condition that can be fatal if not detected early. They can occur spontaneously or after trauma or vascular procedures. The most common aortic fistulas occur with the esophagus, intestines, atrium, and bronchi. Aorto-superior vena cava (SVC) fistulas are exceedingly rare finding. We present a patient with a dissected aortic pseudoaneurysm complicated by an aorto-SVC fistula, leading to left-to-right shunting. This caused increased pulmonary blood flow, left ventricular volume overload, and eventual high-output heart failure. This is a unique case of an aorto-SVC fistula as a complication of subacute/chronic ascending aortic dissection in a patient who …
Myocardial Protection In High-Risk Cardiopulmonary Bypass Support, Subhasis Chatterjee, Marc R. Moon
Myocardial Protection In High-Risk Cardiopulmonary Bypass Support, Subhasis Chatterjee, Marc R. Moon
Journal of Shock and Hemodynamics
The development of cardioplegia has facilitated complex cardiac surgery and allowed high-risk patients to safely tolerate life-saving procedures. By following the principles of electromechanical arrest, inducing hypothermia, and using adjunctive agents to help mitigate the effects of hypothermia and ischemia reperfusion injury, cardioplegia can be safely induced with various commercially available compositions, which can be delivered by several different surgical techniques. Although many studies have compared these methods, there is little consensus on whether any one method is superior to another. Just as a surgeon may need to modify technique according to individual patient factors, so too must a surgeon …
Role Of Midodrine On Vasopressor Duration In Patients With Sepsis, Kamah J. Ellena, Jenna L. Combs, Heather M. Draper, Julie J. Belfer
Role Of Midodrine On Vasopressor Duration In Patients With Sepsis, Kamah J. Ellena, Jenna L. Combs, Heather M. Draper, Julie J. Belfer
Journal of Shock and Hemodynamics
Existing literature evaluating the off-label use of midodrine has focused primarily on postoperative hypotensive patients requiring a single vasopressor. This study aimed to evaluate the impact of midodrine on vasopressor duration and length of stay in patients receiving vasopressors for sepsis-related hypotension. This is an institutional review board-approved, single-center, retrospective analysis of critically ill patients with hypotension secondary to sepsis who received midodrine and intravenous vasopressors compared to those who received intravenous vasopressors alone. Patients were matched by Acute Physiology and Chronic Health Evaluation II score, suspected source of infection, and presence of bacteremia. One hundred patients were included in …
The Brink Of The Abyss: From Transcatheter Aortic Valve Implantation, To Impella, To Left Ventricular Assist Device Destination Therapy, Jake Kieserman, Megan Sheehan, Marisa Cevasco, Brian Mccauley, Ryan Prentice, Jay Giri, Joyce Wald
The Brink Of The Abyss: From Transcatheter Aortic Valve Implantation, To Impella, To Left Ventricular Assist Device Destination Therapy, Jake Kieserman, Megan Sheehan, Marisa Cevasco, Brian Mccauley, Ryan Prentice, Jay Giri, Joyce Wald
Journal of Shock and Hemodynamics
Acute valvular emergencies are common causes of cardiogenic shock. Patients with critical aortic pathologies causing shock frequently undergo percutaneous interventions for valve replacement. However, in cases of persistent cardiogenic shock after valve replacement, there are limited options for further mechanical support. In this case study, we report a patient with a prior history of aortic valve replacement who presented in cardiogenic shock. After a transcatheter aortic valve-in-valve replacement, he remained in persistent shock with worsening clinical parameters requiring escalating inotropic and vasopressor support. With input from a multidisciplinary care team, an Impella 5.5 (Abiomed, Inc.) was placed through the valve …
Hyperthermic Extracorporeal Applied Tumor Therapy (Heatt®) In Advanced Unresponsive Cancer, Joseph B. Zwischenberger, Peyton Skaggs, Katherine Breetz, Jan Winetz, Roger Vertrees
Hyperthermic Extracorporeal Applied Tumor Therapy (Heatt®) In Advanced Unresponsive Cancer, Joseph B. Zwischenberger, Peyton Skaggs, Katherine Breetz, Jan Winetz, Roger Vertrees
Journal of Shock and Hemodynamics
Hyperthermia has been utilized for cancer therapy, including metastatic cancer, for decades with isolated success. Previous research has indicated that the elevated temperature of 42°C induces cell death, apoptosis, or senescence of responsive cancers, providing a mechanism for tumor destruction and management. Veno-venous perfusion-induced systemic hyperthermia (V-V PISH) may be the key to improving advanced tumor responsiveness to previously failed chemotherapy and/or radiation as combination therapy. The most recent iteration of V-V PISH, Hyperthermic Extracorporeal Applied Tumor Therapy (HEATT®), provides homogeneous heating of all tissues with electrolyte and pH control and continues to prove safe and effective. The utilization of …
Journal Of Shock And Hemodynamics, Vol. I, Iss. 2 (Print Version)
Journal Of Shock And Hemodynamics, Vol. I, Iss. 2 (Print Version)
Journal of Shock and Hemodynamics
The print version of Volume I, Issue 2 of the Journal of Shock and Hemodynamics was published in February 2023. The PDF of the print version is downloadable here.
Management Of Patients With Refractory Cardiogenic Shock And Cardiointestinal Syndrome With Impella 5.5 As Bridge To Decision: Case Series, Ismael A. Salas De Armas, Bindu Akkanti, Amanda Bergeron, Anju Bhardwaj, Kha Dinh, Ali Shirafkan, Jayeshkumar A. Patel, Manish K. Patel, Carlos R. Manrique Neira, Igor D. Gregoric, Biswajit Kar, Mehmet H. Akay
Management Of Patients With Refractory Cardiogenic Shock And Cardiointestinal Syndrome With Impella 5.5 As Bridge To Decision: Case Series, Ismael A. Salas De Armas, Bindu Akkanti, Amanda Bergeron, Anju Bhardwaj, Kha Dinh, Ali Shirafkan, Jayeshkumar A. Patel, Manish K. Patel, Carlos R. Manrique Neira, Igor D. Gregoric, Biswajit Kar, Mehmet H. Akay
Journal of Shock and Hemodynamics
Patients with advanced heart failure require multi-system management as a majority succumb to end-organ dysfunction, including gastrointestinal sequelae. Temporizing measures, such as early mechanical circulatory support, can assist in the recovery of patients with acute cardiogenic shock. The temporary support can improve patient characteristics to enable future definitive heart failure therapies such as durable left ventricular assist devices and orthotopic heart transplantation. We present two cases of cardiogenic shock that were successfully bridged with an Impella 5.5 (Abiomed). The management enabled the patients to recover from reversible cardiointestinal syndrome and undergo successful definitive therapies.
Revascularization In Cardiogenic Shock: Residual Syntax Score And Chronic Total Occlusions, Venugopal Menon
Revascularization In Cardiogenic Shock: Residual Syntax Score And Chronic Total Occlusions, Venugopal Menon
Journal of Shock and Hemodynamics
The residual syntax score (rSS) is strongly associated with outcomes in patients with stable coronary artery disease. In patients with acute myocardial infarction-associated cardiogenic shock (AMI-CS), the correlation or association of the rSS, mortality risk, and revascularization strategy has not yet been elucidated and needs more investigation. The SHOCK trial demonstrated that patients with left main and severe triple-vessel disease, who underwent coronary artery bypass grafts, had improved outcomes and higher 1-year survival rates than those with initial medical stabilization. However, it is unclear which is the superior technique for achieving complete revascularization. In contrast to the SHOCK trial’s results, …
Covid-19 Induced Right Ventricular Failure And Right Ventricular Assist Device Support, Marvin Slepian M.D.
Covid-19 Induced Right Ventricular Failure And Right Ventricular Assist Device Support, Marvin Slepian M.D.
Journal of Shock and Hemodynamics
COVID-19, while primarily recognized for its pulmonary and systemic manifestations, afflicts the cardiovascular system through various abnormalities. Notably, right ventricular (RV) involvement leading to dysfunction and failure is a manifestation seen in up to 20% of severe COVID patients. RV severity correlates with overall COVID severity, serving as a prognostic marker. Data review reveals that RV failure was largely underdiagnosed, particularly early on in the pandemic. The therapy approach for RV failure in patients with COVID should focus on supporting overall RV perfusion pressure, maintaining sinus rhythm, optimizing RV loading conditions and contractility, and addressing anticoagulation and thrombus-related conditions. Beyond …
Right Ventricular Hemodynamics In Covid-19 Patients, Steven Hollenberg
Right Ventricular Hemodynamics In Covid-19 Patients, Steven Hollenberg
Journal of Shock and Hemodynamics
The right ventricle is highly sensitive to afterload, and pulmonary compromise can increase pulmonary vascular resistance and lead to right ventricular dysfunction. Pulmonary hypertension can also be exacerbated by mechanical ventilation. Patients with COVID-19 pneumonia and respiratory failure, especially those ventilated with positive end-expiratory pressure, are prone to pulmonary hypertension. Understanding their right ventricular hemodynamics can have therapeutic and prognostic implications.
Coronary Flow And Unloading In Acute Myocardial Infarction Shock, Kiyo Ishikawa
Coronary Flow And Unloading In Acute Myocardial Infarction Shock, Kiyo Ishikawa
Journal of Shock and Hemodynamics
In patients with cardiogenic shock that undergo successful coronary intervention, there are still factors complicating myocardial recovery. There is room for improvement in coronary flow using mechanical circulatory devices, specifically by left ventricular unloading. This idea was further explored in a research study using pigs. Results showed that subjects with acute myocardial infarction who have reduced cardiac contractility and/or high diastolic pressure would benefit from support strategies targeting left ventricular unloading.
The Challenges Of Conducting Clinical Trials For Patients With Cardiogenic Shock, Sunil Rao
The Challenges Of Conducting Clinical Trials For Patients With Cardiogenic Shock, Sunil Rao
Journal of Shock and Hemodynamics
Cardiogenic shock due to ST-segment elevation myocardial infarction is associated with high morbidity and mortality. Patients in shock are acutely ill, and clinicians may lack equipoise, thus presenting a challenge to developing high-quality evidence to guide practice. This review will summarize these challenges and offer possible solutions.
Why Is Epinephrine Not The Drug Of Choice In Cardiogenic Shock?, Esther Vorovich
Why Is Epinephrine Not The Drug Of Choice In Cardiogenic Shock?, Esther Vorovich
Journal of Shock and Hemodynamics
Through the years, epinephrine has been the drug of choice for patients with cardiogenic shock. However, epinephrine was clinically inferior to norepinephrine in comparison studies because of the negative patient outcomes, which were statistically significant. These effects include type B lactic acidosis, tachycardia, increased myocardial oxygen demand, and arrhythmias.
Profound Vasoplegia After Coronary Artery Bypass Grafting, Subhasis Chatterjee
Profound Vasoplegia After Coronary Artery Bypass Grafting, Subhasis Chatterjee
Journal of Shock and Hemodynamics
Vasoplegic shock after cardiac surgery is characterized by a high cardiac output, low systemic vascular resistance, refractory hypotension, and ongoing need for vasopressors. In this case, management considerations are discussed, including vasoactive medications and other adjuncts to sustain a satisfactory mean arterial pressure and improve outcomes.
Reperfusion Injury In Acute Myocardial Infarction Shock- Role Of Mechanical Circulatory Support Devices, Finn Gustafsson
Reperfusion Injury In Acute Myocardial Infarction Shock- Role Of Mechanical Circulatory Support Devices, Finn Gustafsson
Journal of Shock and Hemodynamics
The efficacy of mechanical circulatory support in acute myocardial infarction is dependent upon the size of the infarct. If applied early, mechanical support to reduce reperfusion injury appears to be effective in reducing infarct size in animal studies. The optimal timing of reperfusion is uncertain and requires further investigation. Efficient unloading appears to be essential in increasing the efficacy of the type of mechanical support and may favor one over another.
Racial Variations In Shock Presentation And Outcome, Steven Bailey
Racial Variations In Shock Presentation And Outcome, Steven Bailey
Journal of Shock and Hemodynamics
Working toward inclusive strategies for data sampling, trials, and triage is essential. Whatever the approach, it is important to do better than what has been done in the past when considering race and ethnicity in patient care. Although there may be limited publications with information on this topic, they have shown clear differences in patient outcomes with possible associations with gender, race, and ethnicity. It is critical to view the implications of this on socioeconomic status, access, resources, patient phenotypes, and patient desires and expectations. The disparities must first be recognized before any treatment options can be identified.
Hemodynamic Goals In Shock Management: Is There One Target For All?, Maya Guglin
Hemodynamic Goals In Shock Management: Is There One Target For All?, Maya Guglin
Journal of Shock and Hemodynamics
The current guidelines for managing cardiogenic shock lack specificity and clarification. The main criterion for cardiogenic shock is low cardiac output, and the most important goal is to achieve adequate output from a shock state. Because of the complex nature of cardiogenic shock, a “one-size-fits-all" outline may not be the best solution. Historically, hemodynamic goals in cardiogenic shock are copied from septic shock. Because septic shock and cardiogenic shock are different hemodynamic entities, the goals should be different.
Hemodynamics And Kinetics Of Heart Failure With Preserved Ejection Fraction Shock, Yevgeniy Brailovsky, J. Eduardo Rame, Thierry Le Jemtel, Indranee Rajapreyar
Hemodynamics And Kinetics Of Heart Failure With Preserved Ejection Fraction Shock, Yevgeniy Brailovsky, J. Eduardo Rame, Thierry Le Jemtel, Indranee Rajapreyar
Journal of Shock and Hemodynamics
The classical paradigm of cardiogenic shock is severe impairment of left ventricular, right ventricular, or biventricular contractility resulting in decreased cardiac output and end-organ failure. In patients with preserved ejection fraction, cardiogenic shock results from impaired left ventricular filling leading to decreased cardiac output and end-organ hypoperfusion. Heart failure with preserved ejection fraction (HFpEF) comprises a heterogenous group of myocardial and systemic metabolic derangements. Cardiogenic shock with preserved left ventricular ejection is thought to be less common than with reduced left ventricular ejection fraction, and therapeutic approaches are not well standardized. We aim to review the pathophysiology of cardiogenic shock …
Scai Shock: Does The Stage Help With Management Decisions?, Jacob C. Jentzer, David A. Baran
Scai Shock: Does The Stage Help With Management Decisions?, Jacob C. Jentzer, David A. Baran
Journal of Shock and Hemodynamics
No abstract for an Editorial.
Future Perspectives In Acute Myocarditis Complicated By Cardiogenic Shock, Giovanni A. Tavecchia, Iside Cartella, Enrico Ammirati
Future Perspectives In Acute Myocarditis Complicated By Cardiogenic Shock, Giovanni A. Tavecchia, Iside Cartella, Enrico Ammirati
Journal of Shock and Hemodynamics
Acute myocarditis is an inflammatory disease of the myocardium with a highly variable clinical course. Fulminant myocarditis (FM) represents the most threatening scenario with hemodynamic compromise and cardiogenic shock at presentation. Despite medical advances and the availability of promising mechanical circulatory support (MCS), FM is burdened by a dismal prognosis. Early referral to tertiary hospitals with MCS facilities and prompt diagnosis with endomyocardial biopsy are critical steps toward optimal management. Moreover, beyond supportive care, the prevention of irreversible myocardial damage with immunomodulating therapies must be proven in clinical trials. In this editorial, we briefly describe current evidence and future perspectives …
Surviving Sepsis Campaign: Strategies To Implement In Cardiogenic Shock Management, James Burke Md
Surviving Sepsis Campaign: Strategies To Implement In Cardiogenic Shock Management, James Burke Md
Journal of Shock and Hemodynamics
The Surviving Sepsis Guidelines can serve as a structure to help educate and create a set of recommendations on how to care for patients through this complicated pathway of shock. Designing a cardiogenic shock bundle could reduce the variability of care and possibly improve survival. Also, a more standard protocol would allow a review of the outcomes and a system to change practice nationally when new data or technology becomes available. This could create a continuous quality improvement cycle. Creating a “Surviving Cardiogenic Shock” system could help provide awareness for recognition of cardiogenic shock and advanced management alternatives needed at …
Role Of Invasive Hemodynamics In Shock Management: Is A Pulmonary Artery Catheter Always Necessary?, Ajay J. Kirtane
Role Of Invasive Hemodynamics In Shock Management: Is A Pulmonary Artery Catheter Always Necessary?, Ajay J. Kirtane
Journal of Shock and Hemodynamics
The pulmonary artery (PA) catheter can be a useful tool in the management of patients with cardiogenic shock; however, there are challenges with the use of this catheter, and clinicians must balance the risks and benefits. In addition, clinicians must properly interpret data generated from a PA catheter in the context of other data to optimize a patient's hemodynamics.
Hemodynamic Variations In Cardiogenic Shock Phenotypes, Jason Katz
Hemodynamic Variations In Cardiogenic Shock Phenotypes, Jason Katz
Journal of Shock and Hemodynamics
Patients with cardiogenic shock are not all the same. They present with a variety of hemodynamic profiles and other features that may allow us to create specific phenotypes. It is possible that phenotyping these patients at presentation may then help us to identify the optimal and earliest therapies that will improve outcomes and, at the same time, help us to overcome some of the heterogeneity currently undermining clinical trials.
Pulmonary Hypertension With “Normal” Pulmonary Vascular Resistance, Marwan F. Jumean, Sriram Nathan, Maria Patarroyo Aponte
Pulmonary Hypertension With “Normal” Pulmonary Vascular Resistance, Marwan F. Jumean, Sriram Nathan, Maria Patarroyo Aponte
Journal of Shock and Hemodynamics
Abstracts not available for Perspectives.
Role Of Veno-Arterial Extracorporeal Membrane Oxygenation In Left Ventricular Conditioning After Lung Transplantation, Emily A. Ingebretson
Role Of Veno-Arterial Extracorporeal Membrane Oxygenation In Left Ventricular Conditioning After Lung Transplantation, Emily A. Ingebretson
Journal of Shock and Hemodynamics
End-stage pulmonary hypertension alters intracardiac pressures, leading to distention and failure of the right ventricle, leftward shifting of the intraventricular septum, and, thus, underfilling of the left ventricle (LV). Following the resolution of severely elevated pulmonary vascular resistance with bilateral lung transplantation, the LV is exposed to relatively high filling pressures from a potentially hypertrophic right ventricle pushing blood through normalized pulmonary vascular resistance. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) may be a valuable tool to provide a more gradual exposure of the LV to the newly available preload in the immediate postoperative phase of transplantation, thereby reducing the likelihood …
Scai Shock Stage Classification: What Is Missing From The Latest Update?, Biykem Bozkurt
Scai Shock Stage Classification: What Is Missing From The Latest Update?, Biykem Bozkurt
Journal of Shock and Hemodynamics
The revised Society for Cardiovascular Angiography and Interventions classifications reflect graduation of severity within each stage and pathway by which patients progress or recover. However, they are limited regarding the following: their predictive role to guide therapy; escalation of therapy or referral; variability in diagnostic criteria and interpretation; presence of other disease modifiers and confounders; variability of etiology and reversibility of cause; response to therapy and trajectory to be taken into risk stratification; magnitude and phenotypes of end-organ damage. Thus, we need a modified risk score to predict the necessity to escalate therapy and consider advanced therapies, such as mechanical …
Should All Shock Centers Offer Ecpr? Balancing Futility, Cost Effectiveness, And Hope, Michael Mooney
Should All Shock Centers Offer Ecpr? Balancing Futility, Cost Effectiveness, And Hope, Michael Mooney
Journal of Shock and Hemodynamics
There are over 400,000 out-of-hospital cardiac arrests (OHCA) in the United States annually. Of those, 50% are refractory cardiac arrest, defined as the lack of return of spontaneous circulation (ROSC) after 30 minutes of appropriate cardiopulmonary resuscitation (CPR) in the absence of hypothermia. Extracorporeal cardiopulmonary resuscitation (ECPR) has been increasingly used given its potential to improve survival and offer improved neurological outcomes.
Systemic Inflammatory Response Syndrome And Mechanical Circulatory Support Devices, Mircea R. Mihu, Aly El-Banayosy
Systemic Inflammatory Response Syndrome And Mechanical Circulatory Support Devices, Mircea R. Mihu, Aly El-Banayosy
Journal of Shock and Hemodynamics
Systemic inflammatory response syndrome is an increased inflammatory state affecting the whole body. Mechanical circulatory support (MCS) is a temporary or permanent form of extracorporeal support that may have an associated complication of an exacerbated inflammatory response to the extracorporeal circuit. This brief review will focus on understanding the complex pathophysiology of inflammatory response to MCS, factors that influence the extent of the inflammatory response, the inflammatory response and outcomes as well as potential therapeutic strategies.
Role Of Hypothermia In Cardiogenic Shock, Filio Billia
Role Of Hypothermia In Cardiogenic Shock, Filio Billia
Journal of Shock and Hemodynamics
While patient management in the intensive care unit has undoubtedly improved over the last 20 years, many questions remain. Neurological prognostication has become very important and aided in improving survival outcomes over time. The limited number of randomized control trials and limitations from currently completed studies leave the field with little certainty regarding targeted temperature management. In addition, implementing hypothermia can use multiple methods and protocols that impact the interpretation and comparison of results.
Management Of Severe Aortic Stenosis In Cardiogenic Shock: Early Percutaneous Mechanical Circulatory Support Or Emergent Transcatheter Aortic Valve Replacement?, Sandeep Nathan
Journal of Shock and Hemodynamics
Aortic stenosis (AS) affects an estimated 1.5 million patients in the United States, with 250,000 patients or more suffering severe, symptomatic aortic stenosis. A subset of these patients also have unrevascularized coronary artery disease and left ventricular dysfunction, representing an extreme risk population of AS patients. Cardiogenic shock (CS) complicates a small minority of AS presentations and/or patients referred for transcatheter aortic valve replacement (TAVR) but is responsible in these cases for a disproportionately high rate of morbidity and mortality. Indeed, CS results in a 4-fold increase in TAVR mortality, proportional to shock severity and largely independent of procedural complications. …