One-third of the population in intensive care units is in a state of circulatory shock, whose rapid recognition and mechanism differentiation are of great importance. The clinical context and physical examination are of great value, but in complex situations as in cardiac care units, it is mandatory the use of advanced hemodynamic monitorization devices, both to determine the main mechanism of shock, as to decide management and guide response to treatment, these devices include pulmonary flotation catheter as the gold standard, as well as more recent techniques including echocardiography and pulmonary ultrasound, among others. This article emphasizes the different shock mechanisms observed in the cardiac care units, with a proposal for approach and treatment.

Introduction: Transcatheter aortic valve infective endocarditis is a life-threatening complication. Transcatheter aortic valve infective endocarditis (TAVIE) mortality caused by Candida parapsilosis is unknown. Clinical Case:We present a case of a 73-year-old female diagnosed with severe aortic stenosis secondary to bicuspid aortic valve and coronary artery disease with a significant lesion of the proximal left anterior descending artery, treated with one sirolimus-eluting stent and transcatheter aortic valve replacement. A month later she began with persistent fever and hypotension. A transesophageal echocardiogram (TEE) showed vegetations adhered to the transcatheter aortic valve prosthesis with a moderate posterior paravalvular leak. Positive blood cultures were obtained with Candida parapsilosis isolation. She was treated with Amphotericin B plus voriconazole and underwent surgical aortic valve replacement. Unfortunately, surgery was complicated with aortic and coronary arteries dissection, cardiorespiratory arrest and death.The transesophageal echocardiography had an excellent correlation with surgical findings.

One-third of the population in intensive care units is in a state of circulatory shock, whose rapid recognition and mechanism differentiation are of great importance. The clinical context and physical examination are of great value, but in complex situations as in cardiac care units, it is mandatory the use of advanced hemodynamic monitorization devices, both to determine the main mechanism of shock, as to decide management and guide response to treatment, these devices include pulmonary flotation catheter as the gold standard, as well as more recent techniques including echocardiography and pulmonary ultrasound, among others. This article emphasizes the different shock mechanisms observed in the cardiac care units, with a proposal for approach and treatment.

No abstract