A 68-year-old male is admitted to the ICU following a large anterior myocardial infarction. He is intubated and mechanically ventilated, receiving norepinephrine for hypotension. He is oliguric with signs of poor perfusion. A pulmonary artery catheter is placed for hemodynamic monitoring. Given this clinical presentation and the pathophysiology of cardiogenic shock, which of the following hemodynamic profiles BEST represents the initial compensatory hemodynamic response in cardiogenic shock?

A 68-year-old man is admitted to the intensive care unit with acute chest pain and progressive shortness of breath. On examination, his blood pressure is 80/50 mm Hg, heart rate 115 bpm, and he has cool, clammy extremities. Jugular venous pressure is elevated, and bilateral crackles are heard on lung auscultation. Urine output over the past hour is 15 mL. Laboratory tests reveal a lactate level of 4.5 mmol/L and rising serum creatinine. Which of the following combinations of clinical and laboratory findings is MOST indicative of cardiogenic shock in this patient?

A 62-year-old male on assist-control ventilation is receiving a low-dose norepinephrine infusion via a central venous catheter for persistent hypotension. He now has new peripheral edema, elevated jugular venous pressure, and hepatomegaly. Invasive hemodynamic monitoring shows: right atrial pressure 22 mmHg, pulmonary capillary wedge pressure 10 mmHg, cardiac index 1.8 L/min/m2, and pulmonary artery pulsatility index (PAPi) 0.8. Given these findings, which mechanical circulatory support device is MOST appropriate for this patient’s cardiogenic shock phenotype?

A 65-year-old man is admitted to the intensive care unit following an acute anterior myocardial infarction complicated by cardiogenic shock. His blood pressure is 80/40 mmHg, heart rate is 110 bpm, and he has cool extremities with signs of poor tissue perfusion. Pulmonary artery catheterization reveals a cardiac index of 1.8 L/min/m² (normal 2.5–4.0), pulmonary capillary wedge pressure of 24 mmHg (normal 6–12), and systemic vascular resistance of 2100 dynes·s/cm⁵ (normal 800–1200). Based on these hemodynamic parameters, which of the following pharmacologic interventions is most appropriate as an initial step to improve cardiac output and tissue perfusion?

A 62-year-old male in the ICU presents with refractory hypotension despite norepinephrine support. He reports progressive dyspnea, fatigue, and decreased urine output. On exam, he has cool extremities, pulmonary rales, elevated jugular venous pressure, hypotension (80/50 mmHg), and tachycardia (115 bpm). Oxygen saturation is 92% on FiO₂ 0.6. Laboratory tests reveal elevated lactate (4.8 mmol/L), troponin I (0.8 ng/mL), and NT-proBNP (8,500 pg/mL). Echocardiography shows a left ventricular ejection fraction of 25% with diffuse hypokinesis and no pericardial effusion. Based on the patient’s clinical presentation and diagnostic findings, which of the following combinations MOST strongly supports a diagnosis of cardiogenic shock and helps rule out common mimics?

A 65-year-old man is in the ICU following an acute myocardial infarction complicated by cardiogenic shock. He is mechanically ventilated with an FiO₂ of 0.8 and PEEP of 10 cm H₂O. A norepinephrine infusion is running at 0.2 mcg/kg/min through a central line. Current vital signs are BP 80/50 mmHg (MAP 60 mmHg), HR 115 bpm, and SpO₂ 92%. A pulmonary artery catheter shows a cardiac index of 1.8 L/min/m² and a pulmonary capillary wedge pressure of 22 mmHg. Recent labs show a lactate of 4.5 mmol/L and creatinine of 2.1 mg/dL (baseline 0.9 mg/dL). Physical exam reveals mottled extremities and a urine output of 15 mL/hour over the last 4 hours. Despite the norepinephrine, his MAP has not improved and signs of hypoperfusion are worsening. Based on the patient’s current clinical and hemodynamic status, which SCAI shock stage BEST describes his condition?

A 28-year-old male with known hypertrophic cardiomyopathy (HCM) presents for follow-up after a recent aborted sudden cardiac death event due to resuscitated ventricular fibrillation. He reports mild exertional dyspnea but no syncope and is currently on metoprolol 50 mg twice daily. Echocardiogram reveals a maximal left ventricular wall thickness of 20 mm and a resting left ventricular outflow tract gradient of 30 mm Hg. There is no family history of sudden cardiac death. Considering this clinical scenario, what is the MOST appropriate next step for long-term prevention of sudden cardiac death?

A 68-year-old male is admitted to the critical care unit following an acute anterior myocardial infarction, currently on assist-control ventilation and requiring significant hemodynamic support. A central venous catheter is in place, and his cardiac index is measured at 1.8 L/min/m². His current vital signs are: BP 78/42 mmHg (MAP 54 mmHg), HR 118 bpm, RR 22 breaths/min. Labs reveal a lactate of 4.8 mmol/L. The team is discussing initial vasopressor therapy.

Which of the following pharmacotherapy plans is MOST appropriate to initiate for this patient’s hemodynamic support?

A 62-year-old man is admitted to the ICU after an acute anterior myocardial infarction and is in cardiogenic shock. He is intubated and receiving norepinephrine at 0.1 mcg/kg/min. Vital signs are blood pressure 80/50 mmHg, heart rate 115 bpm, respiratory rate 18 (ventilated), and SpO₂ 94% on FiO₂ 0.6. Hemodynamic measurements reveal a cardiac index of 1.8 L/min/m², pulmonary capillary wedge pressure 22 mmHg, and systemic vascular resistance 1800 dyn·s/cm⁵. Echocardiography shows severe left ventricular dysfunction with an ejection fraction of 20%. Based on these data and current cardiogenic shock guidelines, which pharmacologic agent should be avoided at this time?

A 62-year-old male with ischemic cardiomyopathy is admitted to the ICU with cardiogenic shock (BP 88/60 mm Hg, HR 110 bpm, CVP 14 mm Hg, PCWP 24 mm Hg). Over the past 48 h, he has received IV furosemide boluses, starting at 40 mg twice daily and up-titrated to 80 mg every 6 h. Despite this, his net fluid balance remains +4 L, urine output <0.5 mL/kg/h, and serum creatinine has risen from 1.1 to 1.8 mg/dL (BUN 40 mg/dL). Sodium 138 mEq/L, potassium 4.2 mEq/L, magnesium 1.8 mg/dL, and body weight 85 kg. He remains oliguric despite high-dose loops, indicating diuretic resistance. To optimize fluid removal while minimizing complications, which of the following is the MOST appropriate next step?