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Full-Text Articles in Cardiology

Extracorporeal Rescue In Massive Pulmonary Embolism: A Case Of Chronic Thromboembolic Pulmonary Hypertension Unveiled, Kenzo Ramos, Kari Gorder Jul 2026

Extracorporeal Rescue In Massive Pulmonary Embolism: A Case Of Chronic Thromboembolic Pulmonary Hypertension Unveiled, Kenzo Ramos, Kari Gorder

Journal of Shock and Hemodynamics

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare yet curable cause of pulmonary hypertension from unresolved pulmonary emboli. We present the case of a 48-year-old man with progressive dyspnea and leg swelling, who was found to have bilateral pulmonary emboli with right heart strain. He developed cardiac arrest during thrombectomy, requiring emergent veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Further evaluation revealed acute emboli superimposed on CTEPH. After incomplete thrombectomy and persistent instability, he underwent successful pulmonary endarterectomy with ECMO decannulation, leading to recovery of right ventricular function and discharge in stable condition. This case illustrates that previously unrecognized CTEPH may …


A Reappraisal On The Use Of Mechanical Circulatory Support In Acute Coronary Syndrome And High-Risk Percutaneous Coronary Intervention—Lessons From Stemi-Dtu And Chip-Bcis3, Marwan F. Jumean, Mir Babar Basir, Biswajit Kar May 2026

A Reappraisal On The Use Of Mechanical Circulatory Support In Acute Coronary Syndrome And High-Risk Percutaneous Coronary Intervention—Lessons From Stemi-Dtu And Chip-Bcis3, Marwan F. Jumean, Mir Babar Basir, Biswajit Kar

Journal of Shock and Hemodynamics

None.


Mitral Valve Repair During Cabg Surgery: Navigating The Gray Area Of Moderate Ischemic Mitral Regurgitation, Husam Shadid, Ismael A. Salas De Armas, Marwan F. Jumean Jul 2025

Mitral Valve Repair During Cabg Surgery: Navigating The Gray Area Of Moderate Ischemic Mitral Regurgitation, Husam Shadid, Ismael A. Salas De Armas, Marwan F. Jumean

Journal of Shock and Hemodynamics

Ischemic mitral regurgitation is a consequence of prior myocardial infarction, resulting in regional wall motion abnormalities, leaflet tethering, papillary muscle displacement, and annular dilatation. In patients with multivessel coronary artery disease, approximately 30-50% develop moderate to severe ischemic mitral regurgitation, associated with a threefold increase in the incidence of congestive heart failure and cardiac death. We present a case involving a 66-year-old male with multivessel coronary artery disease, heart failure with reduced ejection fraction (30-35%), and diabetes who was found to have moderate ischemic mitral regurgitation at the time of coronary artery bypass graft surgery. The decision to pursue mitral …


Potential Strategies For Reducing Mortality And Morbidity In Acute Ischemic Cardiogenic Shock, Richard Smalling, James Mccarthy, Tim Henry, Ali Denktas Jun 2025

Potential Strategies For Reducing Mortality And Morbidity In Acute Ischemic Cardiogenic Shock, Richard Smalling, James Mccarthy, Tim Henry, Ali Denktas

Journal of Shock and Hemodynamics

Cardiogenic shock is predominantly caused by acute ischemic myocardial injury. Despite advancements in reperfusion strategies, outcomes remain poor, with the duration of ischemia before reperfusion playing a crucial role in the development of irreversible damage. This review synthesizes insights from animal models and human studies, highlighting the limited myocardial salvage beyond 90 minutes of ischemia. In light of the high mortality rates associated with cardiogenic shock, this review proposes re-evaluating pre-hospital fibrinolysis, exploring left ventricular unloading strategies before reperfusion, and assessing the potential role of endothelin antagonists. These approaches aim to improve outcomes in this high-risk population.


When The Right Ventricle Fails After Left Ventricular Assist Device Implantation: Prediction Tools, Recognition Strategies, And Support Options, Juan Jose Rodriguez Arias, James Schurr, Phyllis Billia, Joyce W. Wald May 2025

When The Right Ventricle Fails After Left Ventricular Assist Device Implantation: Prediction Tools, Recognition Strategies, And Support Options, Juan Jose Rodriguez Arias, James Schurr, Phyllis Billia, Joyce W. Wald

Journal of Shock and Hemodynamics

The incidence of right heart failure (RHF) during durable left ventricular assist device (LVAD) surgery ranges from 9% to 42%, depending on the definition. RHF can be divided into three peri-implantation categories: early acute, early, and late. Despite many available risk models, predicting RHF before durable LVAD implantation has been difficult. Preemptive right-sided temporary mechanical circulatory support can improve outcomes; however, if intraoperative RHF is not suspected, early recognition and appropriate intervention after surgery are important.


Analysis Of The Correlation Between In-Hospital Adverse Events And Transcatheter Aortic Valve Replacement Outcomes, Stanislava Matejin, Pavel Poredos, Anja Boc, Vinko Boc, Wahaj Aman, Igor D. Gregoric, Biswajit Kar Oct 2024

Analysis Of The Correlation Between In-Hospital Adverse Events And Transcatheter Aortic Valve Replacement Outcomes, Stanislava Matejin, Pavel Poredos, Anja Boc, Vinko Boc, Wahaj Aman, Igor D. Gregoric, Biswajit Kar

Journal of Shock and Hemodynamics

Transcatheter aortic valve replacement (TAVR) has been recommended as the standard treatment for elderly patients with severe aortic stenosis (AS) and those at increased risk for conventional surgical procedures. Recently, TAVR has been recognized as the treatment of choice for intermediate-risk patients or even low-risk populations with AS. Our study aimed to identify factors influencing adverse events after TAVR procedures. This single-center, retrospective cohort study involved patients with severe AS treated with TAVR from 2016 to 2019. The patient’s electronic medical record was reviewed, and those with valve-in-valve replacements and missing demographical data were excluded. We analyzed risk factors related …


The Why, The Who, And The How: Launching The Society Of Critical Care Cardiology, Balimkiz Senman, David M. Dudzinski, Ann Gage, P. Elliott Miller, Jason N. Katz Aug 2024

The Why, The Who, And The How: Launching The Society Of Critical Care Cardiology, Balimkiz Senman, David M. Dudzinski, Ann Gage, P. Elliott Miller, Jason N. Katz

Journal of Shock and Hemodynamics

None.


An Unusual Case Of Refractory Hypoxia: The Many Ways Of Providing Oxygen, Saliha Erdem, Mir Babar Basir Aug 2024

An Unusual Case Of Refractory Hypoxia: The Many Ways Of Providing Oxygen, Saliha Erdem, Mir Babar Basir

Journal of Shock and Hemodynamics

This case report outlines the complex clinical course of a 26-year-old female patient who presented with altered mental status after an N-methyl-3,4-methylenedioxy-amphetamine overdose. The patient exhibited profound hemodynamic instability and respiratory failure. She subsequently developed shock, necessitating advanced life support measures, including veno-venous extracorporeal membrane oxygenation with a dual lumen right atrium to pulmonary artery cannula (ProtekDuo; LivaNova, London, UK) and Quadrox Oxygenator (Getinge, Wayne, NJ) system. This resulted in worsening hypoxemia, which was attributed to an increased left ventricular preload. In response, an intra-aortic balloon pump was used to decrease the left ventricle’s afterload. After balloon placement, the patient’s …


Annular Rupture During Transcatheter Aortic Valve Replacement Without A Surgical Option–The Double-Edged Sword Of Mechanical Circulatory Support, Aishah Matar, Corey Adams, Anna Bizios, Rosaleen Chun, Jillian Colbert, Daniel Holloway, Ayaaz K. Sachedina Jul 2024

Annular Rupture During Transcatheter Aortic Valve Replacement Without A Surgical Option–The Double-Edged Sword Of Mechanical Circulatory Support, Aishah Matar, Corey Adams, Anna Bizios, Rosaleen Chun, Jillian Colbert, Daniel Holloway, Ayaaz K. Sachedina

Journal of Shock and Hemodynamics

Transcatheter aortic valve replacement (TAVR) has become a well-established treatment option for patients with severe aortic stenosis. With advances in the field and positive outcomes in clinical trials, TAVR use has expanded from being limited to older patients with prohibitive surgical risk to younger patients with intermediate and low surgical risk. As operators’ experiences have grown and technology has evolved, there are fewer TAVR complications. However, when complications do occur, they remain associated with significant morbidity and mortality. Aortic annulus rupture is a catastrophic complication of TAVR. Risk factors for annulus rupture include valve oversizing, female gender, a large calcification …


An Unusual Case Of Cardiogenic Shock: Coronary Artery Vasospasms, Amanda Bergeron, Maks Mihalj Apr 2024

An Unusual Case Of Cardiogenic Shock: Coronary Artery Vasospasms, Amanda Bergeron, Maks Mihalj

Journal of Shock and Hemodynamics

Coronary artery vasospasms may occur in one or multiple coronary arteries, typically causing transient chest pain or angina. Although rare, it can lead to lethal cardiac arrhythmias, cardiac arrest, or cardiogenic shock and is often misdiagnosed. We report a case of a young man with an atypical presentation of generalized coronary vasospasm leading to cardiac arrest and subsequent cardiogenic shock. The patient required support with veno-arterial extracorporeal membrane oxygenation and Impella. We discuss the risk factors, diagnosis, and treatment of this rare condition.


Aorto-Superior Vena Cava Fistula Secondary To Ascending Aortic Dissection, Talal Al-Assil, Aiden Michael Van Loo, Bakri Kaakeh, Bashar Al Jayyousi, Rania Esteitie Mar 2024

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 Dec 2023

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 Dec 2023

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 Sep 2023

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 Jun 2023

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) Feb 2023

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 Feb 2023

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 Feb 2023

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. Feb 2023

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 Feb 2023

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 Feb 2023

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 Jan 2023

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 Dec 2022

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 Dec 2022

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 Dec 2022

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 Dec 2022

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 Dec 2022

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 Dec 2022

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 Nov 2022

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 Nov 2022

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 …