Approach to the Critical Patient

Immediate priorities

Airway and breathing threats

Cardiogenic shock recognition

Monitoring and targets

Hemodynamic monitoring bundle

Escalation triggers

Immediate consults

Consultation triggers

History

Presentation pattern

Classic heart failure symptoms

Congestion symptoms

Risk factors and triggers

Toxic and medication exposures

Infectious and inflammatory causes

Genetic and familial history

Alarm features

High-risk presentations

Prior cardiac and medical history

Cardiac history

Systemic conditions

Physical Exam

Vital signs and general appearance

Hemodynamic snapshot

General appearance

Cardiovascular exam

Jugular venous assessment

Cardiac auscultation and palpation

Peripheral perfusion

Pulmonary exam

Lung auscultation

Respiratory pattern

Fluid status and end-organ exam

Edema assessment

Abdominal exam

Differential Diagnosis

Life threats and close mimics

Ischemic etiologies

Other cardiomyopathies

Systemic and toxic causes

Valvular and structural mimics

Primary valve disease

Peripartum cardiomyopathy

Laboratory Tests

Core cardiac biomarkers

Natriuretic peptides

Troponin

Metabolic and organ function

Renal function

Hepatic function

Etiologic workup labs

Thyroid function

Inflammatory markers

Genetic and specialized testing

Hematologic and coagulation

Complete blood count

Coagulation screen

Diagnostic Tests

Scoring Systems

Heart failure severity and prognosis tools

Device therapy eligibility criteria

Advanced HF referral triggers

MRI

Cardiac MRI (CMR) role in DCM

CMR contraindications

CT

CT coronary angiography

CT chest indications in DCM

Ultrasound

Echocardiography — primary diagnostic modality

Point-of-care ultrasound (POCUS)

Transesophageal echocardiogram (TEE)

Disposition

Admission indications

Criteria for hospitalization

Level of care selection

ICU indications

Step-down or telemetry indications

Discharge criteria and follow-up

Discharge criteria

Specialist consultation triggers

Treatment

Acute decompensation management

Decongestion therapy

Vasodilation for congestion with adequate BP

Cardiogenic shock

Vasopressor therapy

Inotropic therapy

Mechanical circulatory support

Guideline-directed medical therapy (GDMT)

ACE inhibitor or ARB therapy

Sacubitril-valsartan (ARNI)

Beta-blocker therapy

Mineralocorticoid receptor antagonist (MRA)

SGLT2 inhibitor

Additional pharmacotherapy

Diuretics for congestion

Ivabradine

Hydralazine-isosorbide dinitrate

Anticoagulation

Medications to avoid in DCM

Device therapy

Implantable cardioverter-defibrillator (ICD)

Cardiac resynchronization therapy (CRT)

Etiology-specific treatment

Reversible cause treatment

Inflammatory cardiomyopathy

Special Populations

Pregnancy

Peripartum cardiomyopathy considerations

Medication safety in pregnancy

Obstetric management

Geriatric

Physiologic and presentation differences

Medication modifications

Device therapy in elderly

Goals of care

Pediatrics

Epidemiology in children

Etiology differences

Treatment approach

Background

Epidemiology

Prevalence and incidence

Burden of disease

Sex differences

Pathophysiology

Structural and functional changes

Etiology-specific mechanisms

Complication pathways

Therapeutic Considerations

GDMT initiation and titration principles

Reversibility and recovery

Genetic testing and cascade screening

Arrhythmia and conduction disease management

Patient Discharge Instructions

copy discharge instructions

What is dilated cardiomyopathy

Your medications are critical

Daily weight monitoring is mandatory

Diet and lifestyle

Activity

Warning signs — return to emergency department immediately

Follow-up

References

Guidelines and key sources

Society guidelines

Landmark trials

Key evidence sources

Coding references