[Solved]: A 46 y/o patient with PMH significant for…

A 46 y/o patient with PMH significant for schizoaffective disorder and active tobacco abuse (approx. 90 pack-years, per the patient’s family) presents to the ED with chest pain and shortness of breath. EKG reveals ST elevations in anterior and lateral leads, and the patient was taken for emergent cardiac catheterization. Emergent left-heart angiography reveals severe multi-vessel coronary artery disease, and the interventional cardiology team places an intra-aortic balloon pump for hemodynamic support and improved coronary perfusion pending evaluation for CABG by the CT surgery team. Upon arrival to the ICU, the patient is hypotensive (74/45mmHg, MAP 55), and STAT echocardiogram reveals a markedly-depressed-ejection fraction EF < 30%). SWAN-Ganz catheter reveals CVP 24mmHg, Cardiac Output 2L/Min, and SVR 1500. 1.) Please discuss the pathophysiology of this patient’s acutely decompensated heart-failure and subsequent cardiogenic shock. 2.) Please discuss the management of cardiogenic shock (including pharmacologic and mechanical support options), and implications for the multidisciplinary team.