SlideShare a Scribd company logo
1 of 54
Cardiogenic Shock Nick Tehrani, MD
Definition <90 mmHg <2.2 li/min.m2 >15 mmHg
SHOCK Registry   JACC Sept. 2000, Supp. A   Spectrum of Clinical Presentations 5.6% 28% 65% 1.4% Mortality Respiratory Distress Hypotension Hypoperfusion 21% 22% 70% 60%
Risk Factors for Cardiogenic Shock Due to AMI-mediated LV Dysfunction… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Post-mortem study of Shock hearts ,[object Object],[object Object],[object Object]
Outcomes of Cardiogenic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object]
Outcomes of Cardiogenic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SHOCK registry findings on this point…
Outcomes of Cardiogenic Shock ,[object Object],[object Object],[object Object],[object Object]
Pathophysiology of Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology of Shock ,[object Object],[object Object],[object Object],[object Object]
Pathophysiology of Shock ,[object Object],[object Object],LVEDP (mm Hg)
Pathophysiology of Shock ,[object Object],[object Object]
Schematic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical Stabilization of Shock Pts. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic Effect of IABP in-vivo ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physiologic Effect of IABP in-vivo ,[object Object],[object Object],[object Object],[object Object]
Physiologic Effect of IABP in-vivo ,[object Object]
IABP in Acute MI JACC 1985
IABP in Acute MI ,[object Object],[object Object],[object Object],[object Object],Std. Rx : O2, MSo4, Lido,  Heparin Std Rx + IABP Plus IV NTG
IABP in Acute MI ,[object Object],[object Object],[object Object],[object Object],[object Object]
Utility of IABP in Shock Pts . ,[object Object],[object Object],[object Object],[object Object],[object Object],All this, however, does not add up to improved survival without  Flow Restoration
Thrombolysis in Cardiogenic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object]
BP Effect on efficacy of lytics in Shock ,[object Object],[object Object],[object Object],[object Object],[object Object]
Any Randomized Trials of Thrombolysis in Cardiogenic Shock???? ,[object Object],[object Object],[object Object],[object Object]
Combined IABP and Thrombolysis GUSTO-I : IABP in 62 of the 310 lytic Rx’d Pts. in shock Observational  Data:
Combined IABP and Thrombolysis ,[object Object],[object Object],[object Object],[object Object]
Combined IABP and Thrombolysis Observational  Data from SHOCK Registery :
Combined IABP and Thrombolysis   - Barron, et.al., AHJ June 2001  -National Registry of MI-2, Data base -21,178 pts. Presenting with or developing post-MI shock -32% Received IABP P<0.001 P=NS TT TT IABP PPTCA PPTCA IABP The younger  pts., twice as likely to get TT =>  Selection Bias
Combined IABP and Thrombolysis ,[object Object],[object Object]
Combined IABP and Thrombolysis ,[object Object],[object Object],[object Object],[object Object]
TACTICS ,[object Object],[object Object],Thrombolytic Therapy alone Thrombolytic Therapy  + IABP
TACTICS ,[object Object],[object Object],[object Object]
PATIENT IS IN SHOCK w/ ST elevations, and < 12 hrs Sx onset ,[object Object],[object Object],May  increase the efficacy of Lytics Administration of Lytics  should not be delayed   in anticipation of placement of IABP despite  lack of randomized data  proving efficay.   ,[object Object],[object Object]
SHOCK Trial ,[object Object],[object Object]
SHOCK Trial 302 Pts. with  ST elevation (or  new LBBB ) and  cardiogenic shock Immediate Revascularization  (CABG/PTCA) Late revascularization  (if indicated)   deferred for at least 54 hours ,[object Object],[object Object],[object Object],[object Object]
SHOCK Trial:  Primary end point, 30 days mortality ,[object Object],[object Object],47% 56% Mortality Diff.=13%  P=0.027 50% 63% 52.4% 66.4% Diff.=14% P<0.02 Revasc. Med Rx
SHOCK Trial Why wasn’t the Primary end-point met? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],30 days mortality 47% 56%
SHOCK Trial:  Subgroup analysis, Age less than 75 Revasc. Med Rx P=0.02 CI<1.0 P=0.002 CI<1.0 Mortality 45% 65% 41% 56% 66.7% 48.4% P<0.02 CI<1.0
SHOCK Trial:  What to do with Pt.s older than 75 ,[object Object],[object Object],[object Object],[object Object],[object Object]
What to do with Pt.s older than 75 ,[object Object],[object Object],[object Object]
Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock ,[object Object],Stent  Placement 35.7% 52.3% Revascularization (N=152) Medical Treatment (N=150) IIb/IIIa  Antagonist 41.7% 25%
Role of IIb/IIIa inhibitors in Cardiogenic Shock   ,[object Object],[object Object],[object Object],[object Object],[object Object]
Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock ,[object Object],[object Object],[object Object],[object Object]
Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock ,[object Object],[object Object],[object Object],96 Pt.s w/  Cardiogenic Shock Stent + Reopro N=27 Stent Only N=14 PTCA+Reopro N=18 PTCA Only N=37
Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock Thirty day Mortality Rates (%) Stent+ Reopro Stent Only PTCA+ Reopro PTCA  Only Absence of  Stent use : HR 2.39, 95% CI 1.22 to 4.67, p = 0.01 Absence of  Abciximab use : HR 1.95, 95% CI 1.03 to 3.71, p = 0.04 On Univariate analysis : EF <=30%   HR 3.44, 95% CI 1.35 to 8.78, p = 0.01
Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],At 30 months
Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock ,[object Object],[object Object],[object Object]
Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock ,[object Object],[object Object]
Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock No Reopro With Reopro
Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock Multivariate Analysis
Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock ,[object Object],[object Object],[object Object]
Reversal of Cardiogenic Shock by Percutaneous Left Atrial-to-Femoral Arterial Bypass Assistance   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Take Home Points ,[object Object],[object Object],[object Object],[object Object],[object Object]
Take Home Points ,[object Object],[object Object]

More Related Content

What's hot

Cardiogenic shock - Anesthesiology and ICU
Cardiogenic shock - Anesthesiology and ICUCardiogenic shock - Anesthesiology and ICU
Cardiogenic shock - Anesthesiology and ICUIshfak Maisoor
 
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02Afroza Prioty
 
Non-Specific Intra-Ventricular Conduction Delay - A quick-lit-review
Non-Specific Intra-Ventricular Conduction Delay - A quick-lit-reviewNon-Specific Intra-Ventricular Conduction Delay - A quick-lit-review
Non-Specific Intra-Ventricular Conduction Delay - A quick-lit-reviewSimon Daley
 
Cardiogenic Shock And Arrhythmias
Cardiogenic Shock And ArrhythmiasCardiogenic Shock And Arrhythmias
Cardiogenic Shock And ArrhythmiasAndrew Ferguson
 
Management of Cardiogenic shock
Management of Cardiogenic shockManagement of Cardiogenic shock
Management of Cardiogenic shockNizam Uddin
 
Inotropes and vasopressors in cardiogenic shock
Inotropes and vasopressors in cardiogenic shockInotropes and vasopressors in cardiogenic shock
Inotropes and vasopressors in cardiogenic shockAnwar Yusr
 
Acute Coronary syndrome - Pharmacotherapy
Acute Coronary syndrome - PharmacotherapyAcute Coronary syndrome - Pharmacotherapy
Acute Coronary syndrome - PharmacotherapyAreej Abu Hanieh
 
Advance cardiac life support review
Advance cardiac life support reviewAdvance cardiac life support review
Advance cardiac life support reviewahmad alshareef
 
Management of diastolic heart failure
Management of diastolic heart failureManagement of diastolic heart failure
Management of diastolic heart failureChoying Chen
 
Acute coronary syndrome for critical care exam
Acute coronary syndrome for critical care examAcute coronary syndrome for critical care exam
Acute coronary syndrome for critical care examDr fakhir Raza
 
Anesthesia Management in IHD Patients
Anesthesia Management in IHD PatientsAnesthesia Management in IHD Patients
Anesthesia Management in IHD PatientsReza Aminnejad
 
Heart failure
Heart failureHeart failure
Heart failureNIICS
 
Acute Decompensated Heart Failure
Acute Decompensated Heart FailureAcute Decompensated Heart Failure
Acute Decompensated Heart FailureSCGH ED CME
 

What's hot (20)

Cardiogenic shock - Anesthesiology and ICU
Cardiogenic shock - Anesthesiology and ICUCardiogenic shock - Anesthesiology and ICU
Cardiogenic shock - Anesthesiology and ICU
 
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02
 
Non-Specific Intra-Ventricular Conduction Delay - A quick-lit-review
Non-Specific Intra-Ventricular Conduction Delay - A quick-lit-reviewNon-Specific Intra-Ventricular Conduction Delay - A quick-lit-review
Non-Specific Intra-Ventricular Conduction Delay - A quick-lit-review
 
Cardiogenic Shock And Arrhythmias
Cardiogenic Shock And ArrhythmiasCardiogenic Shock And Arrhythmias
Cardiogenic Shock And Arrhythmias
 
Cardiogenic shock 1
Cardiogenic shock 1Cardiogenic shock 1
Cardiogenic shock 1
 
Cardiogenic shock
Cardiogenic shockCardiogenic shock
Cardiogenic shock
 
Management of Cardiogenic shock
Management of Cardiogenic shockManagement of Cardiogenic shock
Management of Cardiogenic shock
 
Inotropes and vasopressors in cardiogenic shock
Inotropes and vasopressors in cardiogenic shockInotropes and vasopressors in cardiogenic shock
Inotropes and vasopressors in cardiogenic shock
 
Acute Coronary syndrome - Pharmacotherapy
Acute Coronary syndrome - PharmacotherapyAcute Coronary syndrome - Pharmacotherapy
Acute Coronary syndrome - Pharmacotherapy
 
Myocardial infarction
Myocardial infarctionMyocardial infarction
Myocardial infarction
 
Advance cardiac life support review
Advance cardiac life support reviewAdvance cardiac life support review
Advance cardiac life support review
 
Management of diastolic heart failure
Management of diastolic heart failureManagement of diastolic heart failure
Management of diastolic heart failure
 
Acute coronary syndrome for critical care exam
Acute coronary syndrome for critical care examAcute coronary syndrome for critical care exam
Acute coronary syndrome for critical care exam
 
Anesthesia Management in IHD Patients
Anesthesia Management in IHD PatientsAnesthesia Management in IHD Patients
Anesthesia Management in IHD Patients
 
Cardiogenic shock
 Cardiogenic shock Cardiogenic shock
Cardiogenic shock
 
Heart failure
Heart failureHeart failure
Heart failure
 
Chronic Stable Angina- Diagnosis & management
Chronic Stable Angina- Diagnosis & managementChronic Stable Angina- Diagnosis & management
Chronic Stable Angina- Diagnosis & management
 
ITTABV1
ITTABV1ITTABV1
ITTABV1
 
Acute Decompensated Heart Failure
Acute Decompensated Heart FailureAcute Decompensated Heart Failure
Acute Decompensated Heart Failure
 
Anaesthesia for ischemic heart disease
Anaesthesia for ischemic heart diseaseAnaesthesia for ischemic heart disease
Anaesthesia for ischemic heart disease
 

Viewers also liked

Troponin use it in all patients with acute heart failure! pro
Troponin use it in all patients with acute heart failure! proTroponin use it in all patients with acute heart failure! pro
Troponin use it in all patients with acute heart failure! prodrucsamal
 
Guidelines for intraaortic balloon counterpulsation
Guidelines  for intraaortic  balloon  counterpulsationGuidelines  for intraaortic  balloon  counterpulsation
Guidelines for intraaortic balloon counterpulsationDr. Armaan Singh
 
Med j club pd5 in cvd jacc.
Med j club pd5 in cvd jacc.Med j club pd5 in cvd jacc.
Med j club pd5 in cvd jacc.Shaikhani.
 
Advanced treatment in hf ppt
Advanced treatment in hf pptAdvanced treatment in hf ppt
Advanced treatment in hf pptShalini Garg
 
Anatomy of anterior_cruciate_ligament_by- dr. armaan singh
Anatomy of anterior_cruciate_ligament_by- dr. armaan singhAnatomy of anterior_cruciate_ligament_by- dr. armaan singh
Anatomy of anterior_cruciate_ligament_by- dr. armaan singhDr. Armaan Singh
 
Shock And Vasoactive Drugs
Shock And Vasoactive DrugsShock And Vasoactive Drugs
Shock And Vasoactive DrugsMuhammad Badawi
 
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation A...
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation A...2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation A...
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation A...Dr. Juan Carlos Becerra Martinez
 
Recent advances in the role of Cardiac bio-markers for clinical practice
Recent advances in the role of Cardiac bio-markers for clinical practiceRecent advances in the role of Cardiac bio-markers for clinical practice
Recent advances in the role of Cardiac bio-markers for clinical practicesubramaniam sethupathy
 
Cardiacphysiology&anaestheticconsiderationscardiacoutput,pulse,bp,cardiacinde...
Cardiacphysiology&anaestheticconsiderationscardiacoutput,pulse,bp,cardiacinde...Cardiacphysiology&anaestheticconsiderationscardiacoutput,pulse,bp,cardiacinde...
Cardiacphysiology&anaestheticconsiderationscardiacoutput,pulse,bp,cardiacinde...Dr. Armaan Singh
 
Shock : hypovolemic, septic and neurogenic
Shock : hypovolemic, septic and neurogenic Shock : hypovolemic, septic and neurogenic
Shock : hypovolemic, septic and neurogenic Bethelhem Berhanu
 
Cardiac Biomarker past, today and future by Dr. Anurag Yadav
Cardiac Biomarker past, today and future by Dr. Anurag YadavCardiac Biomarker past, today and future by Dr. Anurag Yadav
Cardiac Biomarker past, today and future by Dr. Anurag YadavDr Anurag Yadav
 
Intraaortic Baloon Counterpulsation
Intraaortic Baloon CounterpulsationIntraaortic Baloon Counterpulsation
Intraaortic Baloon CounterpulsationSherif Elbadrawy
 

Viewers also liked (20)

Troponin use it in all patients with acute heart failure! pro
Troponin use it in all patients with acute heart failure! proTroponin use it in all patients with acute heart failure! pro
Troponin use it in all patients with acute heart failure! pro
 
Guidelines for intraaortic balloon counterpulsation
Guidelines  for intraaortic  balloon  counterpulsationGuidelines  for intraaortic  balloon  counterpulsation
Guidelines for intraaortic balloon counterpulsation
 
Med j club pd5 in cvd jacc.
Med j club pd5 in cvd jacc.Med j club pd5 in cvd jacc.
Med j club pd5 in cvd jacc.
 
Advanced treatment in hf ppt
Advanced treatment in hf pptAdvanced treatment in hf ppt
Advanced treatment in hf ppt
 
Cardiac Pacemakers
Cardiac PacemakersCardiac Pacemakers
Cardiac Pacemakers
 
Anatomy of anterior_cruciate_ligament_by- dr. armaan singh
Anatomy of anterior_cruciate_ligament_by- dr. armaan singhAnatomy of anterior_cruciate_ligament_by- dr. armaan singh
Anatomy of anterior_cruciate_ligament_by- dr. armaan singh
 
Shock And Vasoactive Drugs
Shock And Vasoactive DrugsShock And Vasoactive Drugs
Shock And Vasoactive Drugs
 
Cardiogenic shock
Cardiogenic shockCardiogenic shock
Cardiogenic shock
 
Cardiogenic shock
Cardiogenic shockCardiogenic shock
Cardiogenic shock
 
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation A...
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation A...2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation A...
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation A...
 
Pharmacogenomics
PharmacogenomicsPharmacogenomics
Pharmacogenomics
 
Shock
ShockShock
Shock
 
Recent advances in the role of Cardiac bio-markers for clinical practice
Recent advances in the role of Cardiac bio-markers for clinical practiceRecent advances in the role of Cardiac bio-markers for clinical practice
Recent advances in the role of Cardiac bio-markers for clinical practice
 
Cardiacphysiology&anaestheticconsiderationscardiacoutput,pulse,bp,cardiacinde...
Cardiacphysiology&anaestheticconsiderationscardiacoutput,pulse,bp,cardiacinde...Cardiacphysiology&anaestheticconsiderationscardiacoutput,pulse,bp,cardiacinde...
Cardiacphysiology&anaestheticconsiderationscardiacoutput,pulse,bp,cardiacinde...
 
Shock : hypovolemic, septic and neurogenic
Shock : hypovolemic, septic and neurogenic Shock : hypovolemic, septic and neurogenic
Shock : hypovolemic, septic and neurogenic
 
Cardiac Biomarker past, today and future by Dr. Anurag Yadav
Cardiac Biomarker past, today and future by Dr. Anurag YadavCardiac Biomarker past, today and future by Dr. Anurag Yadav
Cardiac Biomarker past, today and future by Dr. Anurag Yadav
 
Cardiogenic shock
Cardiogenic shockCardiogenic shock
Cardiogenic shock
 
Intraaortic Baloon Counterpulsation
Intraaortic Baloon CounterpulsationIntraaortic Baloon Counterpulsation
Intraaortic Baloon Counterpulsation
 
shock
shockshock
shock
 
SHOCK
SHOCKSHOCK
SHOCK
 

Similar to Heart Disease & Chest Pain Treatment At NT Cardiovascular Center Georgia

Cardiogenic shock following acute MI
Cardiogenic shock following acute MICardiogenic shock following acute MI
Cardiogenic shock following acute MIDr. Lokesh Khandelwal
 
Hypertension management- Angina IHD
Hypertension management- Angina IHDHypertension management- Angina IHD
Hypertension management- Angina IHDcardiositeindia
 
myocardial Reperfusion injury
myocardial Reperfusion injurymyocardial Reperfusion injury
myocardial Reperfusion injurydibufolio
 
Anginal pectoris refractory to standard medical therapy i
Anginal pectoris refractory to standard medical therapy iAnginal pectoris refractory to standard medical therapy i
Anginal pectoris refractory to standard medical therapy iBALASUBRAMANIAM IYER
 
14.09.13 high dose statin
14.09.13 high dose statin14.09.13 high dose statin
14.09.13 high dose statinRajeev Agarwala
 
Recent Developments in the Treatment of Hypertension Recent Developments in...
Recent Developments in the Treatment of Hypertension 	 Recent Developments in...Recent Developments in the Treatment of Hypertension 	 Recent Developments in...
Recent Developments in the Treatment of Hypertension Recent Developments in...MedicineAndFamily
 
Bruchanski final x
Bruchanski final xBruchanski final x
Bruchanski final xchiefhgh
 
anticoagulation eng.pptx
anticoagulation eng.pptxanticoagulation eng.pptx
anticoagulation eng.pptxAdliIsmail4
 
Ami Selayang Hospital
Ami Selayang HospitalAmi Selayang Hospital
Ami Selayang HospitalRashidi Ahmad
 
Sleep Apnea and Heart Failure (2001-06-13)
Sleep Apnea and Heart Failure (2001-06-13)Sleep Apnea and Heart Failure (2001-06-13)
Sleep Apnea and Heart Failure (2001-06-13)MedicineAndFamily
 
Septic cmp poster
Septic cmp poster Septic cmp poster
Septic cmp poster jhammes
 
Intervention treatment for acs
Intervention treatment for acsIntervention treatment for acs
Intervention treatment for acsKyaw Win
 

Similar to Heart Disease & Chest Pain Treatment At NT Cardiovascular Center Georgia (20)

Management of Sepsis
Management of SepsisManagement of Sepsis
Management of Sepsis
 
Cardiogenic shock following acute MI
Cardiogenic shock following acute MICardiogenic shock following acute MI
Cardiogenic shock following acute MI
 
Statins+in+ACS
Statins+in+ACSStatins+in+ACS
Statins+in+ACS
 
sabari krishnan
sabari krishnansabari krishnan
sabari krishnan
 
Hypertension management- Angina IHD
Hypertension management- Angina IHDHypertension management- Angina IHD
Hypertension management- Angina IHD
 
myocardial Reperfusion injury
myocardial Reperfusion injurymyocardial Reperfusion injury
myocardial Reperfusion injury
 
Anginal pectoris refractory to standard medical therapy i
Anginal pectoris refractory to standard medical therapy iAnginal pectoris refractory to standard medical therapy i
Anginal pectoris refractory to standard medical therapy i
 
Scientific news march 2015 samir rafla
Scientific news march 2015 samir raflaScientific news march 2015 samir rafla
Scientific news march 2015 samir rafla
 
14.09.13 high dose statin
14.09.13 high dose statin14.09.13 high dose statin
14.09.13 high dose statin
 
Recent Developments in the Treatment of Hypertension Recent Developments in...
Recent Developments in the Treatment of Hypertension 	 Recent Developments in...Recent Developments in the Treatment of Hypertension 	 Recent Developments in...
Recent Developments in the Treatment of Hypertension Recent Developments in...
 
Acute STEMI Rx.pptx
Acute STEMI Rx.pptxAcute STEMI Rx.pptx
Acute STEMI Rx.pptx
 
Hyvet Slide Set
Hyvet Slide SetHyvet Slide Set
Hyvet Slide Set
 
Bruchanski final x
Bruchanski final xBruchanski final x
Bruchanski final x
 
Sepsis And Septic Shock
Sepsis And Septic ShockSepsis And Septic Shock
Sepsis And Septic Shock
 
Devices
DevicesDevices
Devices
 
anticoagulation eng.pptx
anticoagulation eng.pptxanticoagulation eng.pptx
anticoagulation eng.pptx
 
Ami Selayang Hospital
Ami Selayang HospitalAmi Selayang Hospital
Ami Selayang Hospital
 
Sleep Apnea and Heart Failure (2001-06-13)
Sleep Apnea and Heart Failure (2001-06-13)Sleep Apnea and Heart Failure (2001-06-13)
Sleep Apnea and Heart Failure (2001-06-13)
 
Septic cmp poster
Septic cmp poster Septic cmp poster
Septic cmp poster
 
Intervention treatment for acs
Intervention treatment for acsIntervention treatment for acs
Intervention treatment for acs
 

Recently uploaded

Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...astropune
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Lucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel roomLucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel roomdiscovermytutordmt
 
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...narwatsonia7
 
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...jageshsingh5554
 
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service KochiLow Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service KochiSuhani Kapoor
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...Arohi Goyal
 
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...astropune
 
(Rocky) Jaipur Call Girl - 9521753030 Escorts Service 50% Off with Cash ON De...
(Rocky) Jaipur Call Girl - 9521753030 Escorts Service 50% Off with Cash ON De...(Rocky) Jaipur Call Girl - 9521753030 Escorts Service 50% Off with Cash ON De...
(Rocky) Jaipur Call Girl - 9521753030 Escorts Service 50% Off with Cash ON De...indiancallgirl4rent
 
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Servicevidya singh
 
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiRussian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiAlinaDevecerski
 
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls JaipurCall Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipurparulsinha
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...CALL GIRLS
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...chandars293
 
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsBangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsGfnyt
 
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableNehru place Escorts
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Dipal Arora
 

Recently uploaded (20)

Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
 
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Kochi Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
 
Lucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel roomLucknow Call girls - 8800925952 - 24x7 service with hotel room
Lucknow Call girls - 8800925952 - 24x7 service with hotel room
 
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...High Profile Call Girls Coimbatore Saanvi☎️  8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎️ 8250192130 Independent Escort Se...
 
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Bangalore Just Call 9907093804 Top Class Call Girl Service Available
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
 
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service KochiLow Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
Low Rate Call Girls Kochi Anika 8250192130 Independent Escort Service Kochi
 
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
All Time Service Available Call Girls Marine Drive 📳 9820252231 For 18+ VIP C...
 
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
 
(Rocky) Jaipur Call Girl - 9521753030 Escorts Service 50% Off with Cash ON De...
(Rocky) Jaipur Call Girl - 9521753030 Escorts Service 50% Off with Cash ON De...(Rocky) Jaipur Call Girl - 9521753030 Escorts Service 50% Off with Cash ON De...
(Rocky) Jaipur Call Girl - 9521753030 Escorts Service 50% Off with Cash ON De...
 
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Ooty Just Call 9907093804 Top Class Call Girl Service Available
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
 
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls DelhiRussian Escorts Girls  Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
Russian Escorts Girls Nehru Place ZINATHI 🔝9711199012 ☪ 24/7 Call Girls Delhi
 
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls JaipurCall Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❤8445551418 VIP Call Girls Jaipur
 
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira ❤️🍑 8250192130 👄 Independent Escort Service ...
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
 
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsBangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
 
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
 
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
Best Rate (Guwahati ) Call Girls Guwahati ⟟ 8617370543 ⟟ High Class Call Girl...
 

Heart Disease & Chest Pain Treatment At NT Cardiovascular Center Georgia

  • 2. Definition <90 mmHg <2.2 li/min.m2 >15 mmHg
  • 3. SHOCK Registry JACC Sept. 2000, Supp. A Spectrum of Clinical Presentations 5.6% 28% 65% 1.4% Mortality Respiratory Distress Hypotension Hypoperfusion 21% 22% 70% 60%
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18. IABP in Acute MI JACC 1985
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25. Combined IABP and Thrombolysis GUSTO-I : IABP in 62 of the 310 lytic Rx’d Pts. in shock Observational Data:
  • 26.
  • 27. Combined IABP and Thrombolysis Observational Data from SHOCK Registery :
  • 28. Combined IABP and Thrombolysis - Barron, et.al., AHJ June 2001 -National Registry of MI-2, Data base -21,178 pts. Presenting with or developing post-MI shock -32% Received IABP P<0.001 P=NS TT TT IABP PPTCA PPTCA IABP The younger pts., twice as likely to get TT => Selection Bias
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38. SHOCK Trial: Subgroup analysis, Age less than 75 Revasc. Med Rx P=0.02 CI<1.0 P=0.002 CI<1.0 Mortality 45% 65% 41% 56% 66.7% 48.4% P<0.02 CI<1.0
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45. Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock Thirty day Mortality Rates (%) Stent+ Reopro Stent Only PTCA+ Reopro PTCA Only Absence of Stent use : HR 2.39, 95% CI 1.22 to 4.67, p = 0.01 Absence of Abciximab use : HR 1.95, 95% CI 1.03 to 3.71, p = 0.04 On Univariate analysis : EF <=30% HR 3.44, 95% CI 1.35 to 8.78, p = 0.01
  • 46.
  • 47.
  • 48.
  • 49. Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock No Reopro With Reopro
  • 50. Role of IIb/IIIa Inhibitors and Stents in Cardiogenic Shock Multivariate Analysis
  • 51.
  • 52.
  • 53.
  • 54.

Editor's Notes

  1. Not much data to support the last item
  2. MUST CLARIFY MEAN, SYSTOLIC, OR DIASTOLIC?????
  3. LAUNDRY list
  4. Patients with SHOCK were specifically excluded
  5. NEED THIS STUDY TO SEE WHAT THE LYTIC AGENT WAS?????
  6. Lower 1 yr mortality 67% v.s. 57% p=.04 Lowevr 30 day mortality 47.5 v.s. 60%, Increased bleedind complications however
  7. MAY take time, but try to make the RT hand data appear later using print screen etc. OR more to the point just leave it out for the time being to not confuse the matter and bring it up later in the discussion
  8. THEY WENT ON TO ACKNOWLEDGE THE DIFFICULTY OF PERFORMING SUCH A STUDY DUE TO PHYSICIAN BIAS, AND THE DIFFICULTY OF OBTAINING CONSENT IN THE CRITICALLY ILL PATIENTS.
  9. IT is clear that some Who received IABP did not receive TT nor went on to revasculariztion. These pt.s based on what has been presented so far are the ones who had no mortality benefit from placement of the IABP.
  10. 12 month results reported January of 2001.
  11. UNIVARIATE analysis only