Not all cardiogenic shock after acute MI is left-sided — and treating it like it is can be fatal.

In this MurmurMD case discussion, Dr. Chris Brown walks through a young patient with acute MI, progressive shock, and severe right ventricular failure, highlighting how early recognition and biventricular mechanical support (Bipella physiology) stabilized the patient when inotropes and balloon support failed.

This transcript-based conversation focuses on real-time decision-making, including:

• Differentiating acute occlusion from chronic disease in an MI presentation

• Why rising troponins without washout suggested ongoing ischemia

• Recognizing RV failure as the primary shock driver

• Why balloon pump and escalating inotropes worsened physiology

• Early RV unloading with RP support as the first step toward BiPella

• Hemodynamic clues that mandated adding LV unloading

• Why RV support should precede LV support in evolving BiPella shock

• PCI strategy once full biventricular support is established

• Renal recovery after unloading both ventricles

• Using BiPella as a bridge to recovery, LVAD, or transplant decision-making

• Why unloading injured myocardium outperforms pharmacologic stimulation

A clear, real-world example of BiPella physiology saving a failing heart when revascularization alone isn’t enough.

Chapters:

00:00 – Acute MI with shock: LV vs RV failure dilemma

01:00 – Troponin trends and evidence of ongoing ischemia

02:00 – Recognizing RV failure as the dominant problem

03:00 – Why balloon pump and inotropes failed

04:00 – Decision to unload the RV first

05:00 – Transitioning toward BiPella physiology

06:00 – Hemodynamics that triggered LV unloading

07:00 – PCI strategy under biventricular support

08:00 – Renal recovery and early organ response

09:00 – Weaning strategy and support sequencing

10:00 – BiPella as bridge to recovery vs advanced therapies

11:00 – Final lessons: unload, don’t overstimulate

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