Introduction

Critical care admission is sometimes required for cardiology patients. This can be for invasive monitoring, supportive therapy, or both, and may be helpful in patients presenting either electively or urgently to the cardiology department. Cardiopulmonary optimization, if instigated promptly or even sometimes preventively, reduces the risk of developing multiorgan failure and may prevent mortality and major morbidity. When this is a risk, early referral to the critical care unit is paramount.

Elective admissions

Most planned admissions to critical care of elective cardiology patients are for one of three reasons:

1. • high-risk percutaneous coronary intervention (PCI) by angioplasty or stenting;

2. • percutaneous heart valve procedures; or

3. • catheter laboratory procedures involving the use of contrast media in patients with chronic renal failure.

High-risk PCI

Elective PCI of the left main stem (LMS) coronary artery is sometimes offered to patients who are either unsuitable or unwilling to undergo coronary artery bypass grafting ([CABG]; PCI can be done especially if the disease is limited to the ostium or body of the LMS, but disease at the LMS bifurcation is usually not suitable). Such patients are often frail, with preexisting left ventricular (LV) dysfunction and other comorbidities. Because the territory of myocardium supplied by the LMS is large, PCI may cause important haemodynamic instability.