Critical Care and Perioperative Cardiology
Core concepts
Critical care cardiology covers shock, respiratory failure, arrhythmia management, mechanical circulatory support, and perioperative risk. Cardiogenic shock requires rapid identification of congestion and hypoperfusion, early revascularization in ACS, and careful vasopressor or inotrope selection. Perioperative evaluation uses clinical risk indices, functional capacity, and surgery-specific risk. Postoperative troponin elevation must be interpreted with symptoms, ECG, and hemodynamics. Bedside echocardiography helps distinguish cardiogenic, septic, obstructive, and hypovolemic shock.
Question traps
Do not use pulmonary artery catheters routinely without a question they can answer. Avoid fluid boluses in cardiogenic shock with pulmonary edema. Perioperative beta blockade is not routine and can cause hypotension or bradycardia. Do not delay STEMI reperfusion for preoperative clearance. Distinguish septic from cardiogenic shock using bedside echo, lactate, and perfusion findings. Postoperative MI can be silent and atypical.
Worked example / rule of thumb
A patient with acute MI, hypotension, cool extremities, and pulmonary edema needs urgent revascularization and norepinephrine plus inotropic support, not a fluid challenge. Rule: shock is a perfusion diagnosis, not a blood pressure number.