Common Misconceptions ■ The same diuretic doses should work for most patients regardless of renal function. ■ All patients with pulmonary edema and peripheral edema are volume overloaded. ■ Continuous infusion of loop diuretics is no more effective than intermittent bolus therapy. Volume overload, which is a serious complication of cardiac disease, is associated with an increased risk of respiratory failure, prolonged need for mechanical ventilation,…

Common Misconceptions ■ Pulmonary artery catheterization plays no role in the evaluation and treatment of patients in the Cardiac Intensive Care Unit (CICU). ■ Dobutamine is an appropriate treatment of hypotension, regardless of etiology. ■ Milrinone is not used in combination with dobutamine. Sympathomimetic Agents Dopamine ■ Inotropic and vasoactive agents are used to correct or stabilize hemodynamic function in the CICU setting ( Table 17.1…

Common Misconceptions ■ A negative transthoracic echocardiogram excludes acute aortic dissection. ■ All patients, irrespective of risk, presenting with symptoms suggestive of aortic dissection, need urgent CT to rule out acute aortic dissection. ■ Coronary angiography must be performed on all patients prior to emergent surgical repair of aortic dissection. Acute Aortic Dissection ■ Acute dissection (AD) of the thoracic aorta is one of the most…

Common Misconceptions ■ Individuals with chronic hypertension are those most likely to develop a hypertensive emergency. ■ The goal of treatment of hypertensive emergency is to achieve normal blood pressure as soon as possible. ■ Nitroglycerin is a good choice for treatment of hypertension in the absence of ischemic chest pain or pulmonary edema. Definition ■ Hypertensive emergencies are characterized by elevations in blood pressure (BP)…

Common Misconceptions ■ A wide pulse pressure is a hallmark of acute aortic regurgitation. ■ Inotropic agents are useful in acute aortic regurgitation. ■ A widened mediastinum is pathognomonic for acute aortic dissection. ■ In aortic stenosis, a softer murmur indicates less severe stenosis. Aortic Regurgitation Clinical Presentation ■ Aortic regurgitation (AR) occurs as a result of either dilation of the aortic root or disruption of…

Common Misconceptions ■ Sinus tachycardia requires treatment to slow the heart rate. ■ Hemodynamic stability is useful in differentiating ventricular tachycardia from supraventricular tachycardia (SVT). ■ Adenosine is the first treatment of choice for hemodynamically stable SVT. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Common Misconceptions ■ A wide-complex tachycardia that is hemodynamically well tolerated is most likely to be supraventricular tachycardia. ■ It cannot hurt to give a stable patient with a wide-complex tachycardia adenosine or a calcium channel blocker to assess the response of the rhythm. ■ Left ventricular dysfunction is always the cause rather than the consequence of incessant ventricular tachycardia. Ventricular tachycardia (VT) accounts for 5%…

Common Misconceptions ■ Survival following in-hospital cardiac arrest is significantly better than out-of-hospital cardiac arrest. ■ In aortic stenosis, the risk of sudden cardiac death is eliminated following aortic valve replacement. ■ In patients post-myocardial infarction (MI) with severe left ventricular dysfunction, an implantable cardioverter defibrillator (ICD) must be placed prior to discharge to reduce early mortality. Presentation ■ Cardiovascular disease accounts for approximately 1 of…

Common Misconceptions ■ Diuretic therapy should be discontinued in patients with volume overload if they develop asymptomatic mild to moderate reductions in blood pressure or renal function. ■ Diuretic use in patients with volume overload can cause acute kidney injury and should be discontinued if the creatinine rises. ■ Continuous intravenous infusion of diuretics is considered no more effective than bolus in severe acute decompensated heart…

Common Misconceptions ■ The presence of bystander coronary artery disease invalidates a diagnosis of stress cardiomyopathy. ■ Stress cardiomyopathy affects both sexes equally. ■ Uniformly a preceding trigger leads to stress cardiomyopathy. Presentation ■ Stress cardiomyopathy (SCM) is a generally reversible acute cardiac syndrome that was originally described in the Japanese population over 30 years ago. ■ Hence, the term takotsubo (an octopus trap with a…

Common Misconceptions ■ Myocarditis is a rare cause of acute nonischemic cardiomyopathy. ■ Corticosteroids are of benefit in mild to moderately severe acute myocarditis. ■ All patients with eosinophilic myocarditis will have a peripheral eosinophilia. Clinical Presentation ■ Myocarditis is defined as inflammation of the myocardium owing to infection, ischemia, or trauma. ■ Approximately 2.5 million cases of myocarditis and cardiomyopathy were diagnosed globally in 2015.…

Common Misconceptions ■ Acute decompensated heart failure (ADHF) typically presents with hypotension or shock. ■ The diagnosis of ADHF is made on the basis of imaging studies and natriuretic peptide levels. ■ ADHF is a single disease entity. ■ All patients with ADHF require a pulmonary artery catheter. ■ The predominant effect of low-dose nitroglycerin infusion in ADHF is mediated through afterload reduction. Clinical Presentation ■…

Common Misconceptions ■ Cardiogenic shock only occurs in patients with left ventricular systolic function. ■ An intraaortic balloon pump (IABP) reduces mortality in cardiogenic shock. ■ Cardiac function is a key predictor of survival of patients with cardiogenic shock. Clinical Presentation ■ Circulatory shock is characterized by the inability of blood flow and oxygen delivery to meet metabolic demands. ■ Cardiogenic shock is a type of…

Common Misconceptions ■ The mechanical complications of acute myocardial infarction are more common in large infarctions. ■ The mechanical complications of acute myocardial infarction can be treated medically. ■ Patients with ventricular septal rupture should be stabilized for several weeks before surgical repair. ■ Early and effective reperfusion of acute myocardial infarction (MI) has resulted in a substantial decline in the incidence of mechanical complications, including…

Common Misconceptions ■ Right-sided electrocardiogram (ECG) in inferior myocardial infarction (MI) has no value. ■ Cardiogenic shock is not possible with preserved left ventricular (LV) function. ■ Intravenous nitroglycerin or morphine should be given to all patients with acute MI and ongoing chest pain. ■ Infarction of the right ventricle (RV) is a common clinical event, occurring in one-third of patients with inferior MI. ■ Right…

Common Misconceptions ■ β-blockers are contraindicated in patients with acute myocardial infarction with chronic obstructive pulmonary disease. ■ Proton pump inhibitors (PPI) should not be given concomitantly with clopidogrel. ■ Prasugrel improved outcomes compared with clopidogrel, with no increase in fatal bleeding. ■ This chapter focuses on evidence-based adjunctive medical therapies indicated for patients with acute myocardial infarction (MI), both ST elevation MI (STEMI) and non-ST…

Common Misconceptions ■ All patients suffering an acute myocardial infarction will complain of chest pain. ■ In evaluating a patient with a suspected acute coronary syndrome, it is important to note the severity of chest pain on a scale of 1 to 10. ■ The response of chest pain to nitroglycerin or antacids is useful in ruling in or ruling out an acute coronary syndrome as…

Common Misconceptions ■ The physical examination in the Cardiac Intensive Care Unit (CICU) no longer contributes to achieving optimal patient outcomes in the era of ubiquitous laboratory testing and imaging. ■ There is a single normal value for blood pressure. ■ Elevated jugular venous pressure and jugular venous distention are synonymous terms. Vital Signs Respiration ■ The respiratory effort, rate, and pattern should be assessed in…