『SoCCC Pre-Rounds: Bite-Sized Critical Care Cardiology Topics Delivered By Experts』のカバーアート

SoCCC Pre-Rounds: Bite-Sized Critical Care Cardiology Topics Delivered By Experts

SoCCC Pre-Rounds: Bite-Sized Critical Care Cardiology Topics Delivered By Experts

著者： Dr. Balim Senman Dr. Elliott Miller Dr. Simon Parlow Dr. Anthony Carnicelli
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SoCCC Pre-Rounds is your go-to for quick, high-yield insights in critical care cardiology, hosted by members of the Society of Critical Care Cardiology (SoCCC). With only 160 specialists in the U.S., mentorship is rare. This podcast bridges the gap with bite-sized episodes featuring clinical pearls, expert tips, and real-world answers on topics like cardiogenic shock, ECMO, and resuscitation. Perfect for pre-rounds, night shifts, or leveling up anytime. Listen in. Level up. Join the SoCCC community.Dr. Balim Senman, Dr. Elliott Miller, Dr. Simon Parlow, Dr. Anthony Carnicelli 衛生・健康的な生活 身体的病い・疾患
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  • Diagnosis & Management of Pulmonary Hypertension in the CICU with Dr. Manreet Kanwar

    Diagnosis & Management of Pulmonary Hypertension in the CICU with Dr. Manreet Kanwar
    2026/09/04
    Is that "pulmonary hypertension" on the echo report actually driving your patient's shock, or is it just along for the ride? In this episode of SoCCC Pre-Rounds, Dr. Anthony Carnicelli is joined by Dr. Manreet Kanwar, an internationally recognized expert in pulmonary hypertension, cardiogenic shock, mechanical circulatory support, advanced heart failure, and heart transplantation, for a practical discussion on managing pulmonary hypertension in the cardiac intensive care unit. Together, they explore how clinicians can move beyond simply recognizing elevated pulmonary pressures to identifying the underlying disease process driving a patient's deterioration.Dr. Kanwar explains why pulmonary hypertension should be viewed as a hemodynamic finding rather than a standalone diagnosis and why understanding its effect on the right ventricle is central to caring for critically ill patients. The conversation covers early bedside assessment, optimizing preload, the challenges of respiratory support, vasopressor selection, and the careful use of temporary mechanical circulatory support. Throughout the discussion, he emphasizes protecting the right ventricle while treating the underlying cause of pulmonary hypertension.Whether you're admitting a patient with decompensated pulmonary hypertension or managing acute right ventricular failure overnight, this episode provides a thoughtful framework for approaching one of the CICU's most challenging patient populations.Key TakeawaysPulmonary hypertension is a hemodynamic finding that requires identifying and treating the underlying cause.Right ventricular function should guide bedside assessment and management decisions in critically ill patients.Optimal preload is patient-specific and should be individualized rather than managed with blanket rules.Mechanical ventilation can worsen right ventricular failure and should be approached with caution.Norepinephrine and vasopressin are preferred vasopressors for hypotensive patients with pulmonary hypertension, while phenylephrine is generally avoided.Temporary mechanical circulatory support requires a clear exit strategy before implantation.In This Episode[00:00] Introduction[01:37] Defining pulmonary hypertension [04:20] Evaluating the critically ill patient with pulmonary hypertension[06:41] Right ventricular failure and preload management[09:46] Respiratory support and the risks of mechanical ventilation[13:26] Vasopressors and temporary mechanical circulatory support[17:44] Final clinical pearls for intensivists[19:11] Closing remarks Notable Quotes[02:49] "Pulmonary hypertension in itself is not a single disease. It is a hemodynamic finding. The key is to figure out the why." — Dr. Manreet Kanwar[11:13] "If you let the patient be very hypoxic or hypercarbic or wait till they're very acidotic to do something about it, this RV will just give out." — Dr. Manreet Kanwar[14:31] "When in doubt, use Levophed. Norepinephrine is always the drug of choice in all circumstances, period." —Dr. Manreet Kanwar[16:00] "Putting devices in is easy. It's the art of taking them out that becomes very, very tricky." —Dr. Manreet Kanwar[19:01] "Go forth and protect the RVs." — Dr. Manreet KanwarResources and LinksBecome a member of the Community: https://www.soccc.org/subscribeDr. Manreet Kanwarhttps://biologicalsciences.uchicago.edu/faculty/manreet-kanwar-mdhttps://www.linkedin.com/in/manreet-kanwar-aa9897aaDr. Anthony Carnicellihttps://www.soccc.org/https://www.linkedin.com/in/anthony-carnicelli-926a0b88/Supported By:This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community.DisclaimerThis podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.
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    20 分
  • Diagnosing and Managing Acute Heart Transplant Rejection in the CICU with Dr. Shashank Sinha

    Diagnosing and Managing Acute Heart Transplant Rejection in the CICU with Dr. Shashank Sinha
    2026/08/07

    What if a heart transplant patient doesn’t look like they’re in cardiogenic shock, but their graft is quietly failing?


    In this episode of SoCCC Pre-Rounds, host Dr. Balim Senman sits down with Dr. Shashank Sinha, advanced heart failure and transplant cardiologist, Director of the CICU at Inova Heart and Vascular Institute, and co-chair of the SoCCC Research Council, for a practical discussion on recognizing, diagnosing, and managing acute graft dysfunction and heart transplant rejection.


    Designed for residents, fellows, intensivists, and CICU teams, this episode explores why rejection should never be considered in isolation. Dr. Sinha emphasizes maintaining a broad differential that includes infection, tamponade, pulmonary embolism, mixed shock, and other causes of graft dysfunction.


    The conversation covers the unique physiology of the denervated transplanted heart and why significant hemodynamic compromise may develop before hypotension. Dr. Sinha discusses the limitations of troponin and BNP, the importance of lactate and end-organ function trends, and the role of physical examination, point-of-care ultrasound, invasive hemodynamics, and endomyocardial biopsy.


    The episode also breaks down the critical first hour of management, when empiric steroids may be appropriate before biopsy, how to approach simultaneous concern for infection and rejection, and the differences between acute cellular and antibody-mediated rejection. Advanced therapies including plasmapheresis, IVIG, immunomodulatory treatment, and temporary mechanical circulatory support are also discussed.


    Key Takeaways


    • Acute rejection is only one potential cause of graft dysfunction, so a broad differential is essential.

    • Heart transplant recipients can develop significant shock before becoming hypotensive.

    • Lactate, renal function, urine output, and tissue perfusion trends may be more informative than isolated cardiac biomarkers.

    • Endomyocardial biopsy remains the gold standard for diagnosing transplant rejection.

    • Stabilization, diagnostic evaluation, and empiric treatment may need to happen in parallel.

    • Early involvement of transplant and multidisciplinary shock teams is critical.


    In This Episode


    [00:00] Introduction

    [01:15] Meet Dr. Shashank Sinha

    [01:59] Post-transplant case presentation

    [02:52] Differential diagnosis for graft dysfunction

    [03:33] Timing and risk of rejection

    [04:38] Concerning clinical presentations

    [06:24] Cardiac denervation

    [08:05] Diagnostic evaluation and lab work

    [10:33] Imaging and invasive hemodynamics

    [11:47] The first hour of management

    [13:54] Infection vs. rejection

    [14:49] Types of rejection and treatment

    [17:00] Advanced therapies and mechanical support

    [19:19] Assessing graft recovery

    [21:09] Key takeaways

    [22:21] Closing remarks


    Notable Quotes


    [01:45] “Graft dysfunction and transplant rejection really reflect the true multidisciplinary nature of cardiac critical care, and this is one of the most treatable causes of cardiogenic shock if recognized early.” — Dr. Shashank Sinha


    [05:47] “One mistake that I do see commonly is waiting for transplant patients to become hypotensive before we get very worried.” — Dr. Shashank Sinha


    Resources and Links


    Become a member:

    https://www.soccc.org/subscribe


    Dr. Shashank Sinha

    https://www.inova.org/doctors/shashank-s-sinha-md

    https://in.linkedin.com/in/dr-shashank-sinha


    Dr. Balim Senman

    https://www.linkedin.com/in/balim-senman-7561436b/

    https://x.com/BalimSenmanMD

    https://www.soccc.org/


    Supported By


    This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community.


    Disclaimer


    This podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.
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    23 分
  • Vasoactive Medications in the CICU with Dr. Elliott Miller and Dr. Anthony Carnicelli

    Vasoactive Medications in the CICU with Dr. Elliott Miller and Dr. Anthony Carnicelli
    2026/07/03
    How do you choose the right vasoactive medication for a patient in cardiogenic shock? In this episode of SoCCC Pre-Rounds, hosts Dr. Anthony Carnicelli and Dr. Elliott Miller sit down for a practical, high-yield discussion on vasopressors, inotropes, and the real-world decision-making behind vasoactive medication management in the CICU.Designed for residents, fellows, and ICU teams, this episode breaks down the pharmacology, clinical evidence, and bedside application of commonly used vasoactive agents including norepinephrine, dopamine, epinephrine, vasopressin, phenylephrine, dobutamine, and milrinone.Dr. Carnicelli emphasizes a stepwise approach to vasoactive medication management: first understanding the pharmacology and intended physiologic effects, then learning how to apply those principles clinically in complex shock states. The conversation explores the limitations of existing cardiogenic shock data, including the aging SOAP II trial and the landmark DOREMI trial comparing milrinone and dobutamine.The discussion also dives into nuanced scenarios such as LVOT obstruction, severe aortic stenosis, pulmonary hypertension, arrhythmogenic shock, and escalating vasopressor requirements that may signal the need for mechanical circulatory support.Packed with practical teaching pearls and candid reflections from the CICU, this episode offers a thoughtful framework for approaching vasoactive medications beyond algorithms and dogma. Whether you are pre-rounding before sunrise or managing a crashing patient overnight, this episode delivers actionable insights you can apply immediately at the bedside.Norepinephrine remains the preferred first-line vasopressor in most cardiogenic shock patients.Vasopressin is generally avoided in low-output cardiogenic shock due to pure vasoconstrictive effects.Pulmonary hypertension and arrhythmogenic shock may be scenarios where vasopressin is helpful.DOREMI demonstrated no major efficacy or safety differences between milrinone and dobutamine.Vasoactive medication management is often more art than science.[00:00] Introduction [01:51] A two-step approach to teaching vasoactive meds[03:30] The SOAP II trial: Norepinephrine vs. dopamine[06:41] Epinephrine as a first-line agent[08:19] When to avoid norepinephrine[09:57] Using vasopressin in cardiogenic shock[12:32] Phenylephrine in right heart failure[13:48] The DOREMI trial: Milrinone vs. dobutamine[17:32] Final thoughts and interdisciplinary approaches[07:37] " Even if you're defending the MAP with epinephrine, you'll get this characteristic rise in lactate, which is concerning, to say the least." — Dr. Elliott Miller[15:36] "The fact that in a randomized trial there was no evidence of efficacy difference, no difference in survival, but also no difference in safety profile…that speaks volumes." — Dr. Anthony Carnicelli on the DOREMI trial[17:07] "If you choose milrinone and you've made a mistake, you're going to have to live with that mistake for a lot longer than dobutamine." — Dr. Elliott Miller[18:51] "Vasoactive medication management is a bit more of an art than it is a science. So experience goes a long way." — Dr. Anthony CarnicelliResources and LinksBecome a member of the Community: https://www.soccc.org/subscribeDr. Anthony Carnicellihttps://www.getcare.muschealth.org/providers/anthony-carnicelli-1376956714https://www.linkedin.com/in/anthony-carnicelli-926a0b88Dr. Elliott Millerhttps://x.com/ElliottMillerMDhttps://www.soccc.org/Supported By:This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community.DisclaimerThis podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.
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    20 分
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