Cardiovascular Critical Care I

Learning Objectives

Develop an appropriate pharmacotherapeutic regi-

men based on a patient’s hemodynamic status and

objective cardiac findings.

genic shock.

Develop treatment plans for critically ill patients

with cardiovascular diseases, including, but not lim-

ited to, coronary artery disease, arrhythmias, heart

failure (HF), and valvular disease.

Recognize the usefulness of mechanical circulatory

support and heart transplantation for patients with

advanced HF and cardiogenic shock, as well as the

common complications associated with these inter-

ventions.

Arterial blood gas

ACE

Angiotensin-converting enzyme

ACS

Acute coronary syndrome(s)

AF

Atrial fibrillation

ARB

Angiotensin receptor blocker

AV

Atrioventricular

BNP

Brain natriuretic peptide

CABG

Coronary artery bypass grafting

CAD

Coronary artery disease

CVP

Central venous pressure

ECG

Electrocardiography/electrocardiogram

ECHO

Echocardiography/echocardiogram

ECMO

Extracorporeal membrane oxygenation

HF

Heart failure

ICU

Intensive care unit

LV

Left ventricle/ventricular

LVAD

Left ventricular assist device

LVEF

Left ventricular ejection fraction

MAP

Mean arterial pressure

MCS

Mechanical circulatory support

MI

Myocardial infarction

infarction

PCI

Percutaneous coronary intervention

PVR

Pulmonary vascular resistance

RV

Right ventricle/ventricular

SA

Sinoatrial

SAM

Systolic anterior motion of the mitral valve

and Interventions

SVR

Systemic vascular resistance

VAD

Ventricular assist device

VT

Ventricular tachycardia

Self-Assessment Questions

Answers and explanations to these questions may be

found at the end of this chapter.

Questions 1–8 pertain to the following case.

A 58-year-old man (height 71 inches, weight 106 kg)

was transferred to the intensive care unit (ICU) from an

outlying hospital after 24 hours of progressively worsen-

ing chest pain and shortness of breath. He arrives on 6

L of oxygen by high-flow nasal cannula, with a heparin

infusion at 16 units/kg/hour and dopamine infusion at

15 mcg/kg/minute. Notes show that he was bradycardic

(heart rate of 50–58 beats/minute) and hypotensive

(78/49–86/55 mm Hg) on presentation to the outlying

hospital. His 12-lead electrocardiogram (ECG) at the

outlying hospital showed ST-segment elevation in leads

II, III, and aVF. Given his chest pain and ECG findings,

aspirin 324 mg (chewed and swallowed), clopidogrel 600

mg, and morphine 4 mg intravenously once were admin-

istered before transfer. Notes also show that β-blockers

and nitroglycerin were held because of bradycardia and

hypotension.

His past medical history is significant for nonadher-

ence, hypertension, diabetes, dyslipidemia, and heart

failure with preserved ejection fraction (HFpEF), with

a last-reported left ventricular ejection fraction (LVEF)

of 65% 1 year ago. The patient reports that he currently

takes no medications at home.

Hg, heart rate 110 beats/minute, respiratory rate 19

breaths/minute, temperature 99.7°F (37.6°C)

distress, radiating chest pain 7/10, evidence

of rales, absence of any cardiac murmurs, and

presence of a right radial arterial line.

in the reservoir is also present (the patient reports

that his most recent void was yesterday morning).