SoCCC Pre-Rounds: Bite-Sized Critical Care Cardiology Topics Delivered By Experts cover art

SoCCC Pre-Rounds: Bite-Sized Critical Care Cardiology Topics Delivered By Experts

SoCCC Pre-Rounds: Bite-Sized Critical Care Cardiology Topics Delivered By Experts

Written by: Dr. Balim Senman Dr. Elliott Miller Dr. Simon Parlow Dr. Anthony Carnicelli
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SoCCC Pre-Rounds is your go-to for quick, high-yield insights in critical care cardiology, hosted by members of the Society of Critical Care Cardiology (SoCCC). With only 160 specialists in the U.S., mentorship is rare. This podcast bridges the gap with bite-sized episodes featuring clinical pearls, expert tips, and real-world answers on topics like cardiogenic shock, ECMO, and resuscitation. Perfect for pre-rounds, night shifts, or leveling up anytime. Listen in. Level up. Join the SoCCC community.Dr. Balim Senman, Dr. Elliott Miller, Dr. Simon Parlow, Dr. Anthony Carnicelli Hygiene & Healthy Living Physical Illness & Disease
Episodes
  • Cardiogenic Shock in Pregnancy: A Practical CICU Approach with Dr. Ricky Hansra

    Cardiogenic Shock in Pregnancy: A Practical CICU Approach with Dr. Ricky Hansra
    Oct 2 2026

    Managing cardiogenic shock is challenging in any patient. Add pregnancy to the equation, and even experienced cardiac intensivists must navigate a unique set of physiologic, clinical, and ethical challenges.


    In this episode of SoCCC Pre-Rounds, host Dr. Elliott Miller sits down with Dr. Ricky Hansra, co-director of the Cardiac Intensive Care Unit at Vanderbilt and an expert in cardio-obstetrics, for a practical discussion on caring for pregnant patients with cardiogenic shock.


    Together, they explore the foundational principles of managing these critically ill patients, including how pregnancy alters cardiovascular physiology, how to interpret hemodynamics in this unique population, and why supporting maternal circulation is central to supporting fetal well-being.


    Dr. Hansra discusses the role of pulmonary artery catheterization, bedside hemodynamic monitoring, vasopressor and inotrope selection, and the use of mechanical circulatory support including ECMO. He shares practical CICU pearls on anticoagulation strategies, delivery planning, and managing the challenges created by a growing uterus during mechanical support.


    The conversation also covers the care of patients with pre-existing cardiomyopathy during pregnancy, including optimization strategies, multidisciplinary planning, and coordination between cardiology, maternal-fetal medicine, obstetrics, anesthesia, cardiac surgery, and critical care teams.


    Designed for residents, fellows, intensivists, cardiologists, and CICU teams, this episode provides a practical framework for approaching one of the most complex scenarios in critical care cardiology: the pregnant patient in cardiogenic shock.


    Key topics covered:


    • Initial approach to cardiogenic shock during pregnancy
    • Understanding normal pregnancy physiology and abnormal hemodynamics
    • Pulmonary artery catheter use in the CICU
    • Vasopressor and inotrope selection
    • ECMO and mechanical circulatory support considerations
    • Anticoagulation and delivery planning
    • Managing cardiomyopathy during pregnancy
    • The importance of multidisciplinary cardio-obstetric care


    Dr. Ricky Hansra


    https://medicine.vumc.org/department-directory/Barinder-Hansra

    https://x.com/RickyHansra


    Dr. Elliot Miller

    https://x.com/ElliottMillerMD

    https://www.soccc.org/


    Supported By:


    This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community.


    Disclaimer

    This podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.
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    19 mins
  • Diagnosis & Management of Pulmonary Hypertension in the CICU with Dr. Manreet Kanwar

    Diagnosis & Management of Pulmonary Hypertension in the CICU with Dr. Manreet Kanwar
    Sep 4 2026
    Is that "pulmonary hypertension" on the echo report actually driving your patient's shock, or is it just along for the ride? In this episode of SoCCC Pre-Rounds, Dr. Anthony Carnicelli is joined by Dr. Manreet Kanwar, an internationally recognized expert in pulmonary hypertension, cardiogenic shock, mechanical circulatory support, advanced heart failure, and heart transplantation, for a practical discussion on managing pulmonary hypertension in the cardiac intensive care unit. Together, they explore how clinicians can move beyond simply recognizing elevated pulmonary pressures to identifying the underlying disease process driving a patient's deterioration.Dr. Kanwar explains why pulmonary hypertension should be viewed as a hemodynamic finding rather than a standalone diagnosis and why understanding its effect on the right ventricle is central to caring for critically ill patients. The conversation covers early bedside assessment, optimizing preload, the challenges of respiratory support, vasopressor selection, and the careful use of temporary mechanical circulatory support. Throughout the discussion, he emphasizes protecting the right ventricle while treating the underlying cause of pulmonary hypertension.Whether you're admitting a patient with decompensated pulmonary hypertension or managing acute right ventricular failure overnight, this episode provides a thoughtful framework for approaching one of the CICU's most challenging patient populations.Key TakeawaysPulmonary hypertension is a hemodynamic finding that requires identifying and treating the underlying cause.Right ventricular function should guide bedside assessment and management decisions in critically ill patients.Optimal preload is patient-specific and should be individualized rather than managed with blanket rules.Mechanical ventilation can worsen right ventricular failure and should be approached with caution.Norepinephrine and vasopressin are preferred vasopressors for hypotensive patients with pulmonary hypertension, while phenylephrine is generally avoided.Temporary mechanical circulatory support requires a clear exit strategy before implantation.In This Episode[00:00] Introduction[01:37] Defining pulmonary hypertension [04:20] Evaluating the critically ill patient with pulmonary hypertension[06:41] Right ventricular failure and preload management[09:46] Respiratory support and the risks of mechanical ventilation[13:26] Vasopressors and temporary mechanical circulatory support[17:44] Final clinical pearls for intensivists[19:11] Closing remarks Notable Quotes[02:49] "Pulmonary hypertension in itself is not a single disease. It is a hemodynamic finding. The key is to figure out the why." — Dr. Manreet Kanwar[11:13] "If you let the patient be very hypoxic or hypercarbic or wait till they're very acidotic to do something about it, this RV will just give out." — Dr. Manreet Kanwar[14:31] "When in doubt, use Levophed. Norepinephrine is always the drug of choice in all circumstances, period." —Dr. Manreet Kanwar[16:00] "Putting devices in is easy. It's the art of taking them out that becomes very, very tricky." —Dr. Manreet Kanwar[19:01] "Go forth and protect the RVs." — Dr. Manreet KanwarResources and LinksBecome a member of the Community: https://www.soccc.org/subscribeDr. Manreet Kanwarhttps://biologicalsciences.uchicago.edu/faculty/manreet-kanwar-mdhttps://www.linkedin.com/in/manreet-kanwar-aa9897aaDr. Anthony Carnicellihttps://www.soccc.org/https://www.linkedin.com/in/anthony-carnicelli-926a0b88/Supported By:This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community.DisclaimerThis podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.
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    20 mins
  • Diagnosing and Managing Acute Heart Transplant Rejection in the CICU with Dr. Shashank Sinha

    Diagnosing and Managing Acute Heart Transplant Rejection in the CICU with Dr. Shashank Sinha
    Aug 7 2026

    What if a heart transplant patient doesn’t look like they’re in cardiogenic shock, but their graft is quietly failing?


    In this episode of SoCCC Pre-Rounds, host Dr. Balim Senman sits down with Dr. Shashank Sinha, advanced heart failure and transplant cardiologist, Director of the CICU at Inova Heart and Vascular Institute, and co-chair of the SoCCC Research Council, for a practical discussion on recognizing, diagnosing, and managing acute graft dysfunction and heart transplant rejection.


    Designed for residents, fellows, intensivists, and CICU teams, this episode explores why rejection should never be considered in isolation. Dr. Sinha emphasizes maintaining a broad differential that includes infection, tamponade, pulmonary embolism, mixed shock, and other causes of graft dysfunction.


    The conversation covers the unique physiology of the denervated transplanted heart and why significant hemodynamic compromise may develop before hypotension. Dr. Sinha discusses the limitations of troponin and BNP, the importance of lactate and end-organ function trends, and the role of physical examination, point-of-care ultrasound, invasive hemodynamics, and endomyocardial biopsy.


    The episode also breaks down the critical first hour of management, when empiric steroids may be appropriate before biopsy, how to approach simultaneous concern for infection and rejection, and the differences between acute cellular and antibody-mediated rejection. Advanced therapies including plasmapheresis, IVIG, immunomodulatory treatment, and temporary mechanical circulatory support are also discussed.


    Key Takeaways


    • Acute rejection is only one potential cause of graft dysfunction, so a broad differential is essential.

    • Heart transplant recipients can develop significant shock before becoming hypotensive.

    • Lactate, renal function, urine output, and tissue perfusion trends may be more informative than isolated cardiac biomarkers.

    • Endomyocardial biopsy remains the gold standard for diagnosing transplant rejection.

    • Stabilization, diagnostic evaluation, and empiric treatment may need to happen in parallel.

    • Early involvement of transplant and multidisciplinary shock teams is critical.


    In This Episode


    [00:00] Introduction

    [01:15] Meet Dr. Shashank Sinha

    [01:59] Post-transplant case presentation

    [02:52] Differential diagnosis for graft dysfunction

    [03:33] Timing and risk of rejection

    [04:38] Concerning clinical presentations

    [06:24] Cardiac denervation

    [08:05] Diagnostic evaluation and lab work

    [10:33] Imaging and invasive hemodynamics

    [11:47] The first hour of management

    [13:54] Infection vs. rejection

    [14:49] Types of rejection and treatment

    [17:00] Advanced therapies and mechanical support

    [19:19] Assessing graft recovery

    [21:09] Key takeaways

    [22:21] Closing remarks


    Notable Quotes


    [01:45] “Graft dysfunction and transplant rejection really reflect the true multidisciplinary nature of cardiac critical care, and this is one of the most treatable causes of cardiogenic shock if recognized early.” — Dr. Shashank Sinha


    [05:47] “One mistake that I do see commonly is waiting for transplant patients to become hypotensive before we get very worried.” — Dr. Shashank Sinha


    Resources and Links


    Become a member:

    https://www.soccc.org/subscribe


    Dr. Shashank Sinha

    https://www.inova.org/doctors/shashank-s-sinha-md

    https://in.linkedin.com/in/dr-shashank-sinha


    Dr. Balim Senman

    https://www.linkedin.com/in/balim-senman-7561436b/

    https://x.com/BalimSenmanMD

    https://www.soccc.org/


    Supported By


    This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community.


    Disclaimer


    This podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.
    Show More Show Less
    23 mins
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