Basics of the Impella

Impella is a temporary heart pump. A microaxial pump sucks blood from the ventricle and propels it systemically or to the lungs depending on where it is placed (left or right ventricle, respectively). The device is shaped to travel with the natural curvature of the heart
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🤔Why use it?
Depending on size used, it can deliver 2.5-5L of blood flow/min. For reference, normal blood flow at rest is ~5-6L/min. It is doing the work of the heart when it physically can’t. Thus its used in cardiogenic shock and patients with poor heart function to assist in protected high risk PCI (percutaneous coronary intervention- placement of stents)
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👩‍⚕️👨‍⚕️Who inserts it?
Interventional cardiologists in the cath lab via the femoral or axillary artery as a short term tool while awaiting cardiac recovery or as a bridge (±ECMO) in anticipation of possible permanent solutions (i.e. LVAD, transplant)
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🔑 Limitations/Complications
1️⃣Size: Impella requires a large sheath. Left sided Impella may not be suitable for patients with significant peripheral vascular disease, or diseased narrow arteries of the body
2️⃣To prevent thrombus (clot) formation we use anticoagulation (blood thinner). So there is risk of both thrombus formation and bleeding . Impella can also cause turbulent blood flow causing hemolysis and can worsen anemia🩸
3️⃣Downstream limb ischemia
4️⃣Micro emboli & plaque disruption➡️stroke, peripheral embolization
5️⃣Damage to the myocardium, aortic valve
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🔑Contraindications
1️⃣Mechanical aortic valves
2️⃣Significant aortic stenosis/regurgitation
3️⃣LV thrombus
4️⃣LV rupture
5️⃣Cardiac tamponade
6️⃣Severe PAD
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🔑 Comments
Limited data exists on efficacy of Impella in cariogenic shock compared to IABP as quite difficult to study these very sick patients. Regardless, remains a valuable tool in the cardiologist’s armamentarium. Remember: 1️⃣ newer does not always mean better and 2️⃣every medication/therapy has intrinsic risks/benefits
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🩺👀👉🏻Some of the original images from a doc you should follow: ‪@Yourheartdoc‬
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#Cardiology #Medicine #MedSchool #DocsOfInstagram #TikTokDoc #NursingTips #MedSchoolTips #InterventionalCardiology #Nurses #NursingSchool #NursingStudent #MedicineExplained #echocardiography #premed #PreMedTips

[@yunglee2315]

Hello sir, My name is karthick am from India.. Currently am I'm in my final year of my med school.. Sir what do you think the future of interventional cardiology and electrphysiology in next 20 years?.. Am very much interested in CT SURGERY.. BUT my professors and seniors strongly condemn my decision to choose a career in CT SURGERY.. THEY SAID VERY SOON MOST OF THE PROCEDURES WILL BE REPLACED BY INTERVENTIONAL CARDIOLOGY.. CAN YOU COMMENT YOUR VIEWS IN THIS STATEMENT?.. THANK YOU SIR YOUR'S RESPECTFULLY KARTHICK

[@MarcKatzMD]

We will forever and always need CT surgeons

[@yunglee2315]

@@MarcKatzMD thanks for your warm reply sir 😊

[@RichardC313]

Hey man, how was your internal medicine residency? Did you know you were going to specialize into cardiology beforehand?

[@MarcKatzMD]

In med school I actually thought I wanted to go into family medicine or surgery. Didn’t love either. Internal medicine was the choice for me (kzbin.info/www/bejne/b4Xcpmx-pLSkn9E) because I could be a primary internist or specialize further. In residency I went back and forth between IM and cardiology but always had an incline towards the specialty. So I didn’t know from the beginning but it kind of grew out of my interest in cardiac anatomy and physiology. As for residency- I did it at Hahnemann/Drexel before it shut down. And it was inner city Philly and was quite exhausting and challenging. That’s residency for you but being in an underserved area and a hospital that was completely ran by teaching services it was quite busy. It was not something I LOVED in the moment but it gave me great training which I appreciate in retrospect

[@RichardC313]

@@MarcKatzMD Thank you for the reply. That residency sounds action packed lol. I think I'm leaning more towards the internal medicine/cardiology fellow route and was curious how your IM residency was. I love cardiology and am an ECG nerd. Internal medicine seems like 3 years I want to run past to get to cardiology but I'm trying to be open and maybe look forward IM residency right after med school. Anyway, thanks again for your reply man I appreciate the informative response! Hope you have a nice day man.

[@MarcKatzMD]

@@RichardC313 just make sure you’d be okay being an internist. Cardiology fellowship is quite competitive and not a guarantee. Good luck!

[@RichardC313]

@@MarcKatzMD Hard pill to swallow! Thanks man will do.

[@michaelm5852]

Keep on rockin'!!! This content desperately needs Promo-SM!!!

[@josorto3701]

Impella is short term or long term? Can you use as a bridge to transplant?

[@MarcKatzMD]

It's short-term. In can be used in patients in cardiogenic shock who may be going for eventual transplant but that situation is not common/routine. Separately, LVAD's are different things altogether and are surgically implanted within the left ventricle and can be destination therapy or a bridge to transplant

[@alanfinnegan2526]

I must invent a new pump tat could be use as a heart

[@francoisegallant1270]

Francais