Teaching Pearls:

• Ischemic cardiomyopathy is most common cause for development of LV thrombus.
• Cardiogenic shock
  • MAP = CO x SVR
    • MAP decreased due to CO decrease. SVR increases to compensate.
  • Most commonly caused by ischemic cardiomyopathy
  • Presence of transaminitis, AKI, elevated lactic acid suggestive of hypoperfusion (cardiogenic shock)
• Murmurs
  • Left sided heart disease
    • Murmurs decrease with inspiration
  • Right sided heart disease
    • Murmurs increase with inspiration
  • Squatting Test
    • Increases preload back to the heart
    • Causes increased intensity in all murmurs except HOCM and MVP
  • Valvsalva
    • Decreases preload back to the heart
    • Causes decreased intensity in all murmurs except HOCM and MVP
  • Fixed split S2
    • Due to ASD
    • Inspiration causes increased preload, leading to delayed P2 sound (causing the split)
    • Expiration causes increased blood return to left side of heart, which flows through ASD to right side of heart, also causing delayed P2 sound (causing the split).
    • Inspiratory and expiratory causes same effect towards P2, leading to fixed split S2.