Lesson Objectives:

• Recognize and manage cardiogenic shock, pericarditis, myocarditis, and endocarditis.

• Differentiate life-threatening vs. non-life-threatening cardiac emergencies.

• Understand emergency stabilization and ICU management.

Cardiogenic Shock – Recognizing & Managing Acute Pump Failure

🚨 Definition:
A state of end-organ hypoperfusion due to severe cardiac dysfunction.

✔️ Common Causes:

• Acute MI (most common cause, especially LV failure).

• Severe heart failure (HFrEF, decompensated).

• Mechanical complications (papillary muscle rupture, VSD post-MI).

• Massive pulmonary embolism (PE) → Right heart failure.

✔️ Hemodynamic Profile (Swan-Ganz Catheter Findings):

• Low CO (<2.2 L/min/m²)

• High PCWP (>18 mmHg) (suggests left heart failure).

• SVR↑ (systemic vasoconstriction as compensation).

✔️ Management:

• Stabilization: ABCs, oxygenation, IV access.

• Vasopressors: Norepinephrine (first-line) or dobutamine (if no hypotension).

• Mechanical support: IABP (Intra-aortic balloon pump), VA-ECMO in severe cases.

• Definitive therapy: PCI or CABG (if post-MI), LVAD if severe failure.

Pericarditis – When Chest Pain is NOT a Heart Attack

✔️ Classic Presentation:

• Pleuritic chest pain (worse lying flat, better leaning forward).

• Pericardial friction rub on auscultation.

• Diffuse ST elevations on ECG (concave, no reciprocal ST depressions).

✔️ Causes:

• Viral (most common – Coxsackie, echovirus).

• Post-MI (Dressler’s syndrome, weeks after infarct).

• Uremia, autoimmune disease (SLE, RA).

✔️ Management:

• NSAIDs + Colchicine (first-line).

• Steroids only if refractory (risk of recurrence).

• Pericardiocentesis if cardiac tamponade develops.

Endocarditis – A Deadly Infection of the Heart Valves

✔️ Duke’s Criteria for Diagnosis:

• Major: Positive blood cultures (Staph, Strep viridans), Echo with vegetation.

• Minor: Fever, embolic signs (Janeway lesions, splinter hemorrhages).

✔️ Treatment:

• Empiric IV Antibiotics: Vancomycin + Gentamicin (until cultures return).

• Surgery if: Large vegetations, prosthetic valve involvement, abscess.