Immediate in-hospital outcomes after percutaneous revascularization of acute myocardial infarction complicated by cardiogenic shock

BACKGROUND Cardiogenic shock(CS)is a life-threatening complication of acute myocardial infarction with high morbidity and mortality rates.Primary percutaneous coro-nary intervention(PCI)has been shown to improve outcomes in patients with CS.AIM To investigate the immediate mortality rates in patients with CS undergoing primary PCI and identify mortality predictors.METHODS We conducted a retrospective analysis of 305 patients with CS who underwent primary PCI at the National Institute of Cardiovascular Diseases,Karachi,Pak-istan,between January 2018 and December 2022.The primary outcome was immediate mortality,defined as mortality within index hospitalization.Uni-variate and multivariate logistic regression analyses were performed to identify predictors of immediate mortality.RESULTS In a sample of 305 patients with 72.8%male patients and a mean age of 58.1±11.8 years,the immediate mortality rate was found to be 54.8%(167).Multivariable analysis identified Killip class IV at presentation[odds ratio(OR):2.0;95%co-nfidence interval(CI):1.2-3.4;P=0.008],Multivessel disease(OR:3.5;95%CI:1.8-6.9;P<0.001),and high thrombus burden(OR:2.6;95%CI:1.4-4.9;P=0.003)as independent predictors of immediate mortality.CONCLUSION Immediate mortality rate in patients with CS undergoing primary PCI remains high despite advances in treatment strategies.Killip class IV at presentation,multivessel disease,and high thrombus burden(grade≥4)were identified as independent predictors of immediate mortality.These findings underscore the need for aggressive management and close monitoring of patients with CS undergoing primary PCI,particularly in those with these high-risk characteristics.

Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock

Background The prognostic role of diabetes mellitus(DM)in elderly patients with myocardial infarction-related cardiogenic shock(MI-CS)remains controversial.Little information exists about the impact of intensive cardiac care unit(ICCU)and revascularization on outcomes of elderly patients with MI-CS.We aimed to assess the prognostic impact of DM according to age in patients with MI-CS,and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages.Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System’s Basic Data Set.Centers were classified according to their availability of ICCU.Main outcome measured was in-hospital mortality.Results A total of 23,590 episodes of MI-CS were identified,of whom 12,447(52.8%)were in patients aged≥75 years.The impact of DM on in-hospital mortality was different among age subgroups.While in younger patients,DM was associated to a higher mortality risk(0.52 vs.0.47,OR=1.12,95%CI:1.06–1.18,χ^2<0.001),this association became non-significant in older patients(0.76 vs.0.81,χ^2=0.09).Adjusted mortality rate of MI-CS aged≥75 years was lower in patients admitted to hospitals with ICCU(adjusted mortality rate:74.2%vs.77.7%,P<0.001)and in patients undergoing revascularization(74.9%vs.77.3%,P<0.001).Conclusions Prognostic impact of DM in patients with MI-CS was different according to age,with a significantly lower impact at older ages.The availability of ICCU and revascularization were associated with better outcomes in these complex patients.

Effect of Shenfu injection on microcirculation effect index in early-and middle-stage of cardiogenic shock rats

OBJECTIVE Shenfu injection(SFI)is an effective treatment of cardiogenic shock,the pathology of the central link was microcirculation disturbance.However,whether the microcirculation status of the early-and mid-stage of cardiogenic shock has any difference is unclear.This study aimed to observe the effect of SFI on the microcirculatory disturbance in mesentery for early-and mid-stage of cardiogenic shock rat.METHODS The early-and mid-stage model of cardiogenic shock was established by ligating the ending or root of left anterior descending coronary arteries(LADCA).The rats were randomly divided into 9 groups,ie control group,early-stage model group,mid-stage model group,3 early medicated groups and 3 mid medicated groups(the dosage was 1,3.33,10 mL·kg^(-1) SFI for cardiogenic shock rats of early-and mid-stage,respectively).Parameters in mesenteric microcirculation,such as velocity of RBCs in venules,diameters of venules,the count of leukocyte adhesion and vascular permeability which calculated by FITC-dextran leakage were observed through an GeneandiM2 inverted intravital microscope and high-speed video camera system.RESULTS The cardiogenic shock induced by ligating the LADCA resulted in a number of responses in microcirculation,including a significant increase in the counts of adhesive leukocytes,narrowing of the vascular diameter,decrease in the velocity of RBCs and dextran efflux.All of the above parameters for early-stage cardiogenic shock rats were attenuated by the treatment with SFI,especially the dosage of 10 mL·kg^(-1).While SFI had no apparent time-effect on the vascular diameter and vascular permeability in mesentery for mid-stage cardiogenic shock rats.CONCLUSION The microcirculation status of the early-and mid-stage of cardiogenic shock rats were quite different.The efficacy of early treatment with SFI was more obvious than the mid administration,which could provide experimental and theoretical basis for the patients with cardiogenic shock in an earlier time.

An unusual case of renal calculi leading to myocardial infarction and cardiogenic shock

INTRODUCTION The presentation of cardiogenic shock(CS)is usually straightforward,and includes hypotension,absence of hypovolemia,and clinical signs of poor tissue perfusion such as oliguria,cyanosis,cool extremities and altered mentation.^([1])

Cardiogenic shock in the setting of acute myocardial infarction:Another area of sex disparity?

Cardiogenic shock in the setting of acute myocardial infarction(AMI)carries significant morbidity and mortality,despite advances in pharmacological,mechanical and reperfusion therapies.Studies suggest that there is evidence of sex disparities in the risk profile,management,and outcomes of cardiogenic shock complicating AMI.Compared with men,women tend to have more comorbidities,greater variability in symptom presentation and are less likely to receive timely revascularization and mechanical circulatory support.These factors might explain why women tend to have worse outcomes.In this review,we highlight sex-based differences in the prevalence,management,and outcomes of cardiogenic shock due to AMI,and discuss potential ways to mitigate them.

Use of Impella cardiac axial flow pump for cardiogenic shock(A newer alternative)-How good is the evidence?

The adverse outcomes of a ventricular heart failure(left,right or biventricular)caused by cardiogenic shock are aggravated by lung oedema and organ mal perfusion.Despite advances in medical sciences,revascularisation and mechanical hemodynamic support have proved ineffective in reducing the mortality rate in such patients.A thorough study of the data available about cardio-vascular diseases reveals that the application of conventional methods of treatment are least helpful to practically restore normal functions of heart when it experiences end-stage systolic ventricular failure.Thus,to overcome the challenges and find alternatives to address this issue,percutaneous ventricular support devices/machines were designed and successfully introduced.These devices have revolutionized the treatment of ventricular heart failures and are now in use all over the world.In this review paper a newer mechanical circulatory support(MCS)device,Impella,has been discussed and compared with a few other devices like(Intra-aortic Balloon Pump(IABP),Extracorporeal Circulation(ECLS)and Veno-arterial Extracorporeal Membrane Oxygenation(VA-ECMO).This article studies the challenges being faced during the treatment of cardiogenic shock,and thoroughly discusses the use and effectiveness of Impella Cardiac Axial Pump in each emergency.It can be said that mechanical circulatory support(MCS)device use during percutaneous coronary intervention(PCI)should be individualized based on multiple factors with a recommended use in patients with the greatest potential benefit and a relatively low risk of device-related complications.The current literature suggests that the outcomes of use of Impella and other mechanical circulatory support devices like IABP and VA-ECMO are comparable.Though there seem to be a few advantages of Impella over the others,sufficiently powered,multi-centric,randomised control trials are needed to establish its superiority.

Temporary coronary sinus pacing to improve ventricular dyssynchrony with cardiogenic shock: A case report

BACKGROUND Temporary transvenous pacing through the coronary sinus is a novel approach rarely used in treating unstable bradycardia.This modality could provide cardiac pacing while achieving better ventricular synchrony.We present a case who received cardiac pacing through the coronary sinus and provide a summary of evidence in the current literature.CASE SUMMARY A 55-year-old woman with a history of advanced heart failure was admitted to the rehabilitation ward after a recent stroke.During hospitalization,she had paroxysmal atrial fibrillation with rapid ventricular response resulting from fluid overload.While atrial fibrillation was spontaneously reversed to sinus rhythm after diuresis,she developed multiple episodes of polymorphic ventricular tachycardia along with sinus bradycardia and prolonged QTc interval.She became hypotensive despite appropriate medical management.Pacing through her implantable cardioverter-defibrillator was attempted but worsened her hypotension.Ventricular dyssynchrony was suspected.Temporary transvenous atrial pacing through the coronary sinus was performed,which stabilized her blood pressure and improved end-organ perfusion.A permanent biventricular pacemaker was later implanted,and she was safely discharged to a nursing home.CONCLUSION Temporary transvenous pacing through the coronary sinus,a novel approach to treat unstable bradycardia,may reduce ventricular dyssynchrony.

Pulmonary artery catheterization in acute myocardial infarction complicated by cardiogenic shock:A review of contemporary literature

Acute myocardial infarction(AMI)with left ventricular(LV)dysfunction patients,the most common cause of cardiogenic shock(CS),have acutely deteriorating hemodynamic status.The frequent use of vasopressor and inotropic pharmacologic interventions along with mechanical circulatory support(MCS)in these patients necessitates invasive hemodynamic monitoring.After the pivotal Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness trial failed to show a significant improvement in clinical outcomes in shock patients managed with a pulmonary artery catheter(PAC),the use of PAC has become less popular in clinical practice.In this review,we summarize currently available literature to summarize the indications,clinical relevance,and recommendations for use of PAC in the setting of AMI-CS.

Interventional Cardiology Management of a Cardiogenic Shock Induced by Takotsubo Cardiomyopathy at the Hospital Center of Montlucon: A Case Report

Background: Takotsubo cardiomyopathy is frequently considered as a benign disorder. We present an atypical form with cardiogenic shock that was managed by interventional cardiology measures. Case presentation: A 58 years old female patient with a past history of hypertension, obesity and multiple sclerosis was admitted at the Hospital Center of Montlucon for septic shock of urinary origin. During hospitalization in intensive care unit, the patient presented a markedly increasing of troponin levels with a diffused ST-segment elevation. Transthoracic Echocardiography showed an altered left ventricular ejection fraction at 35% with hypokinesia of apex and lateral ventricular segments in conjunction with compensatory hyperkinesis of the base;these findings were strongly suggestive of a diagnosis of Takotsubo cardiomyopathy. Despite concomitant anemia, renal failure and sepsis, all adequately treated with complete remission, the patient developed frequent episodes of ventricular tachycardia that prompted an emergency coronarography. During this procedure, the patient presented a cardiogenic shock and bradyasystole that were successfully managed by intra-aortic balloon pumping and temporary transvenous pacing. Finally, there were no coronary lesions and ventriculography confirmed a Takotsubo cardiomyopathy. Given the unstable hemodynamic status of this patient, she was addressed to the University Teaching Hospital of Clermont-Ferrand for more specialized care. Conclusion: This case alerts the physician to be more vigilant when managing all patients with Takotsubo cardiomyopathy, because some cases could be fatal. In severe cases, intra-aortic balloon pumping and temporary epicardial pacing can be life-saving.

The Utility of B-type Natriuretic Peptide to Predict Prognosis of Acute Myocardial Infarction Patients Complicated With Cardiogenic Shock Treated With Intra-aortic Ballon Counterpulsation

Objectives To assess the prognostic value of B-type natriuretic peptide （BNP） in severe AMI patients treated with intra-aortic ballon counterpulsation（IABP）. Methods A total of 42 AMI patients with cardiogenic shock were retrospectively studied. BNP plasma level was recorded in the 24th hour and 4th day after myocardial infarction. The different mortality were compared among patients with different BNP levels. Results With aggressive treatment, 20 patients survived short term hospitalization. Plasma concentration of BNP in dying patients is much higher than in survivals（1369 ± 353 vs 651 ± 302 pg/ml. P〈 0.01）.Patients with BNP higher than 1474 pg/mL had a mortality of 92.9 %. Conclusions Elevated BNP level in AMI patients with cardiogenic shock treated with IABP is highly associated with poor prognosis.

Results of 50 adult patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock

Objective Extracorporeal membrane oxygenation is a cardiopulmonary supportive therapy. Since 2004,our institution has adopted venoarterial ECMO for adult patients who otherwise could not be weaned from cardiopulmonary bypass and patients experiencing postcardiotomy cardiogenic shock and / or pulmonary dysfunction

The role of temporary mechanical circulatory support in de novo heart failure syndromes with cardiogenic shock:A contemporary review

Cardiogenic shock(CS)is a complex clinical syndrome with a high mortality rate.It can occur to due to multiple etiologies of cardiovascular disease and is phenotypically heterogeneous.Acute myocardial infarction-related CS(AMI-CS)has historically been the most prevalent cause,and thus,research and guidance have focused primarily on this.Recent data suggest that the burden of non-ischemic CS is increasing in the population of patents requiring intensive care admission.There is,however,a paucity of data and guidelines to inform the management of these patients who fall into two broad groups:those with existing heart failure and CS and those with no known history of heart failure who present with"de novo"CS.The use of temporary mechanical circulatory support(MCS)has expanded across all etiologies,despite its high cost,resource intensity,complication rates,and lack of high-quality outcome data.Herein,we discuss the currently available evidence on the role of MCS in the management of patients with de novo CS to include fulminant myocarditis,right ventricular(RV)failure,Takotsubo syndrome,post-partum cardiomyopathy,and CS due to valve lesions and other cardiomyopathies.

The medical treatment of cardiogenic shock

Cardiogenic shock (CS) is a leading cause of mortality worldwide. CS presentation and management in the current era have been widely depicted in epidemiological studies. Its treatment is codified and relies on medical care and extracorporeal life support (ECLS) in the bridge to recovery, chronic mechanical device therapy, or transplantation. Recent improvements have changed the landscape of CS. The present analysis aims to review current medical treatments of CS in light of recent literature, including addressing excitation–contraction coupling and specific physiology on applied hemodynamics. Inotropism, vasopressor use, and immunomodulation are discussed as pre-clinical and clinical studies have focused on new therapeutic options to improve patient outcomes. Certain underlying conditions of CS, such as hypertrophic or Takotsubo cardiomyopathy, warrant specifically tailored management that will be overviewed in this review.

Hemodynamic monitoring in cardiogenic shock

Cardiogenic shock(CS)is a life-threatening condition characterized by acute end-organ hypoperfusion due to inadequate cardiac output that can result in multiorgan failure,which may lead to death.The diminished cardiac output in CS leads to systemic hypoperfusion and maladaptive cycles of ischemia,inflammation,vasoconstriction,and volume overload.Obviously,the optimal management of CS needs to be readjusted in view of the predominant dysfunction,which may be guided by hemodynamic monitoring.Hemodynamic monitoring enables(1)characterization of the type of cardiac dysfunction and the degree of its severity,(2)very early detection of associated vasoplegia,(3)detection and monitoring of organ dysfunction and tissue oxygenation,and(4)guidance of the introduction and optimization of inotropes and vasopressors as well as the timing of mechanical support.It is now well documented that early recognition,classification,and precise phenotyping via early hemodynamic monitoring(e.g.,echocardiography,invasive arterial pressure,and the evaluation of organ dysfunction and parameters derived from central venous catheterization)improve patient outcomes.In more severe disease,advanced hemodynamic monitoring with pulmonary artery catheterization and the use of transpulmonary thermodilution devices is useful to facilitate the right timing of the indication,weaning from mechanical cardiac support,and guidance on inotropic treatments,thus helping to reduce mortality.In this review,we detail the different parameters relevant to each monitoring approach and the way they can be used to support optimal management of these patients.

The research of HSPB1 in apoptosis,autophagy and cardiogenic shock

Cardiogenic shock(CS)is a common cause of mortality and treatment remains challenging despite advances in therapeutic options.CS is caused by severe impairment of myocardial performance that results in decreased cardiac output,hypoperfusion of the end organ,and hypoxia.Clinically this presents as hypotension refractory to volume resuscitation with features of end-organ hypoperfusion requiring pharmacological or mechanical intervention.Acute myocardial infarction(AMI)accounts for 81%of patients with CS.Heat shock protein family B member 1(HSPB1)is a multifunctional protein induced by various stress factors and has a protective effect on cells.A large number of studies have demonstrated that HSPB1 plays an important role in regulating apoptosis.Recently,some studies have suggested that HSPB1 also participates in the autophagic process.HSPB1 are expressed in many cells of the cardiovascular system such as endothelial cells,cardiac muscle cells,monocytes,and platelets.They are up-regulated in response to inflammation,oxidative stress,or ischemia and protect cells against extracellular stress factors.Here,we explore the involvement of HSPB1 in apoptosis,autophagy,and CS.We speculate that HSPB1 may exert its anti-myocardial injury role via the regulation of apoptosis and autophagy;this may provide the basis for the development of new approaches for the prevention and treatment of CS.

Efficacy of Intra-aortic Balloon Pump before versus after Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock from ST-elevation Myocardial Infarction

Background： Previous studies showed that patients with cardiogenic shock （CS） from ST-elevation acute myocardial infarction （STEMI） supported by intra-aortic balloon pump （IABP） before primary percutaneous coronary intervention （PCI） decreased the risk of in-hospital mortality than patients who received IABP after PCI. However, little evidence is available on the optimal order of IABP insertion and primary PCI. The aim of this study was to investigate the impact of the sequence of IABP support and PC1 and its association with major adverse cardiac and cerebrovascular events （MACCEs）. Methods： Data were obtained from 218 consecutive patients with CS due to STEMI in Beijing Anzhen Hospital between 2008 and 2014% who were treated with 1ABP and PCI. The patients were divided into two groups： Group A in whom IABP received before PCI （n = 106） and Group B in whom IABP received after PCI （n = 112）. We evaluated the myocardial perfusion using myocardial blush grade and resolution of ST-segment elevation. The primary endpoint was 12-month risk of MACCE. Results： Most baseline characteristics were similar in patients between the two groups. However, patients received 1ABP before PCI were associated with a delay of door-to-balloon time （DBT） and higher troponin I level （P 〈 0.05）. However, myocardial perfusion was significantly improved in patients treated with IABP before PCI （P 〈 0.05）. Overall, IABP support before PCI was not associated with significantly lower risk of MACCE （P 〉 0.05）. In addition, risk of all-cause mortality, bleeding, and acute kidney injury （AKI） was similar between two groups （P 〉 0.05）. Multivariate analysis showed that DBT （odds ratio [OR] 2.5, 95% confidence interval [C/] 1.1-4.8, P=0.04）, lABP support after PCI （OR 5.7, 95% Cl 2.7-8.4, p〈0.01）, and AKI （OR 7.4, 95% CI 4.9 10.8, P- 0.01） were the independent predictors of mortality at 12-month follow-up. Conclusions： Early IABP insertion before primary PCI is associated with improved myocardial perfusion although DBT increases. IABP support before PCI does not confer a 12-month clinical benefit when used for STEMI with CS.

Candidates and allocation time for extracorporeal membrane oxygenation in patients with cardiogenic shock

Extracorporeal membrane oxygenation(ECMO)is a last resort life support in several patients with cardiogenic shock.However,appropriate candidates and optimal timing of ECMO initiation need to be established.The present report reviewed relevant literatures to refine the allocation of ECMO in patients with cardiogenic shock.The PubMed database was searched from inception to October 5,2020,using the following search terms:"extracorporeal membrane oxygenation"or"mechanical circulatory support"AND"cardiogenic shock"or"cardiac arrest"or"myocardial infarction"or"fulminant myocarditis."The etiology of cardiogenic shock,widened QRS duration,QTc interval prolongation,cardiac arrest,dynamic narrowing of pulse pressure,and speed of lactate accumulation per unit time can be associated with the course of cardiogenic shock,and typically warn that advanced medical circulatory support is required.In the critical moment when the circulatory status deteriorates sharply,an immediate physical examination combined with ready-to-use tools such as monitoring data or blood gas analysis results is crucial for assessing the appropriateness and timing of ECMO initiation.

Impact of liver cirrhosis on ST-elevation myocardial infarction related shock and interventional management,a nationwide analysis

BACKGROUND Critical care is rapidly evolving with significant innovations to decrease hospital stays and costs.To our knowledge,there is limited data on factors that affect the length of stay and hospital charges in cirrhotic patients who present with STelevation myocardial infarction-related cardiogenic shock(SRCS).AIM To identify the factors that increase inpatient mortality,length of stay,and total hospital charges in patients with liver cirrhosis(LC)compared to those without LC.METHODS This study includes all adults over 18 from the National Inpatient Sample 2017 database.The study consists of two groups of patients,including SRCS with LC and without LC.Inpatient mortality,length of stay,and total hospital charges are the primary outcomes between the two groups.We used STATA 16 to perform statistical analysis.The Pearson's chi-square test compares the categorical variables.Propensity-matched scoring with univariate and multivariate logistic regression generated the odds ratios for inpatient mortality,length of stay,and resource utilization.RESULTS This study includes a total of 35798453 weighted hospitalized patients from the 2017 National Inpatient Sample.The two groups are SRCS without LC(n=758809)and SRCS with LC(n=11920).The majority of patients were Caucasian in both groups(67%vs 72%).The mean number of patients insured with Medicare was lower in the LC group(60%vs 56%)compared to the other group,and those who had at least three or more comorbidities(53%vs 90%)were significantly higher in the LC group compared to the non-LC group.Inpatient mortality was also considerably higher in the LC group(28.7%vs 10.63%).Length of Stay(LOS)is longer in the LC group compared to the non-LC group(9 vs 5.6).Similarly,total hospital charges are higher in patients with LC($147407.80 vs$113069.10,P≤0.05).Inpatient mortality is lower in the early percutaneous coronary intervention(PCI)group(OR:0.79<0.11),however,it is not statistically significant.Both early Impella(OR:1.73<0.05)and early extracorporeal membrane oxygenation(ECMO)(OR:3.10 P<0.05)in the LC group were associated with increased mortality.Early PCI(-2.57 P<0.05)and Impella(-3.25 P<0.05)were also both associated with shorter LOS compared to those who did not.Early ECMO does not impact the LOS;however,it does increase total hospital charge(addition of$24717.85,P<0.05).CONCLUSION LC is associated with a significantly increased inpatient mortality,length of stay,and total hospital charges in patients who develop SRCS.Rural and Non-teaching hospitals have significantly increased odds of extended hospital stays and higher adjusted total hospital charges.The Association of LC with worse outcomes outlines the essential need to monitor these patients closely and treat them early on with higher acuity care.Patients with early PCI had both shorter LOS and reduced inpatient mortality,while early Impella was associated with increased mortality and shorter LOS.Early ECMO is associated with increased mortality and higher total hospital charges.This finding should affect the decision to follow through with interventional management in this cohort of patients as it is associated with poor outcomes and immense resource utilization.

Epidemioclinics, Etiologies and Prognosis of Cardiogene Shock State in the Intensive Care Unit of the Cardiology Department of the G-Spot Hospital

Objective: The work aimed to describe the etiological and evolutionary aspects of cardiogenic shock in the intensive care unit of the cardiology department (USIC) of the G-spot hospital in Bamako, Mali. Materials and Methods: This was a descriptive cross-sectional study from January 1, 2018 to April 30, 2019 that included all patients admitted to the USIC during this period. Each patient benefited from individual data support with systematic recording of socio-demographic, clinical, complementary and therapeutic data and analyzed with the SOFTWARE SPSS 20.0 French version. Results: The study involved 40 patients out of 311 patients hospitalized in USIC, representing a hospital frequency of 12.86%. Males were the most affected (60%) with a sex ratio of 1.50. The modal class was 41 - 60 years with extremes at 18 years and 89 years. Cardiovascular risk factors were dominated by HTA (27.50%), diabetes and tobacco, each with 22.50%. The general signs were tachycardia (90%), oxygen desaturation (77.50%), impregnable blood pressure (62.50%), agitation (52.50%) and an oliguria (70%). At the electrocardiogram the rhythm was sinus (80%), it was an atrial fibrillation (15%), a ventricular tachycardia (10%) and signs of coronary ischemia (necrosis in 35% and ST over shifted in 20% of cases). At cardiac doppler ultrasound,the left ventricle was dilated (50%), the right cavities dilated (30%), segmental kinetic disorder (40%), the left ventricular systolic function (FEVG) impaired (75%) and valve disease (10%). Biology noted hyper-creatinemia (65%), hyper-glycemia (12.50%), anemia and hyponatremia with 20% frequency each. Among etiology, ischemic heart disease accounted for 57.50% followed by pulmonary embolism 20%, dilated valve cardiomyopathy 7.50% and chronic pulmonary heart 2.50%. The trend in the majority of cases was unfavorable with 60% of deaths. Chronic pulmonary heart and pulmonary embolism were the deadliest with a frequency of 100% and 87.50% respectively. Conclusion: Cardiogenic shock is an infrequent condition with a high mortality of a prognosis. Ischemic heart disease is the most common etiology of the disease.

Non Hodgkin’s Lymphoma with Right Atrial Intra Cardiac Metastases

Background: Diffuse Large B-Cell Lymphoma (DLBCL) is the most variant of Non-Hodgkin’s Lymphoma (NHL) and also the most common variant with secondary intracardiac masses. Case summary: 7 years old child presented to emergency with acute decompensated cardiac failure, ascites and tender hepatomegaly. 2D echo evaluation was suggestive of large intracardiac mass in the right atrium almost completely obstructing Tricuspid valve orifice, gross pericardial effusion and dilated Inferior Vena Cava (IVC). Emergency tumor excision surgery was performed which revealed 4 × 4 cm pinkish firm mass arising from anterior Tricuspid annulus which was completely excised. Child was extubated on postoperative day (POD) 0 and was on minimal inotropic support. Ascites reduced significantly on POD1 allowing abdominal palpation which revealed a mass in the epigastric region. This prompted evaluation by pediatrician and oncology workup suggestive of increased 18-Flouro Deoxy Glucose (18-FDG) uptake in the mediastinum, abdomen, bilateral proximal thighs, all mediastinal lymph nodal stations, bilateral lung hilar stations 10R, 10L involving all encasing the heart and great vessels with pleural deposits, Celiac trunk, superior Mesenteric Artery (SMA), Portal vein, IVC and abdominal aorta. Histo pathology Examination (HPE) and Immuno Histo Chemistry (IHC) of intracardiac mass revealed DLBCL which is metastatic in nature. Chemotherapy was started as per (French American British Lymphomes Malins B) FAB LMB-96 protocol with the child currently in the Induction phase having poor prognosis and less survival interval. Conclusion: Surgery can be considered a treatment option for metastatic intracardiac masses during emergency scenarios like cardiogenic shock to relieve obstruction along the pathway of blood flow in the heart even though we may not be able to completely excise the tumor surgically.