Chapter 27: Disorders of Cardiac Function, and Heart Failure and Circulatory Shock

The chapter distinguishes between ST-elevation myocardial infarction and non-ST elevation acute coronary syndromes, explaining how myocardial tissue necrosis occurs when coronary blood flow is compromised and outlining the temporal relationship between symptom onset and cardiac necrosis. Diagnostic approaches are integrated throughout, including nuclear imaging techniques, cardiovascular magnetic resonance imaging, computed tomography angiography, and invasive cardiac catheterization procedures that allow clinicians to visualize coronary anatomy and assess ventricular function. Therapeutic interventions receive detailed coverage, encompassing percutaneous coronary intervention strategies, coronary artery bypass grafting, and structured cardiac rehabilitation protocols designed to optimize recovery and prevent recurrence. The chapter then addresses structural and functional cardiac disorders, classifying cardiomyopathies into distinct pathophysiologic categories such as hypertrophic and dilated forms, each with characteristic remodeling patterns and hemodynamic consequences. Inflammatory conditions including myocarditis are explored as potential causes of myocardial dysfunction. Acquired valvular abnormalities are examined for their effects on cardiac output and systemic circulation. Congenital heart disease receives discussion within the context of developmental anomalies, including fetal circulatory adaptations and the hemodynamic consequences when normal postnatal transitions fail to occur, resulting in neonatal hypoxemia and systemic compromise. Throughout the chapter, the unifying theme connects structural or functional cardiac abnormalities to their effects on systemic perfusion and tissue oxygenation.