2022 AMI Online Salon
- Entrant Name: Lohitha Kethu
- Client: Journal of the American Medical Association
- Copyright: American Medical Association, 2021
- Medium/software used: Adobe Photoshop, Illustrator
- Final presentation format: Journal publication
- Primary Audience: Physicians, surgeons
Cardiogenic shock (CS) is a complex, progressive spiral of events that occurs when the heart cannot pump enough blood to itself and vital organs, also called hypoperfusion. In CS due to acute myocardial infarction, occlusion of the affected coronary artery results in myocardial ischemia and the heart’s ventricular function decreases due to less contractile mass. Related decreased cardiac output and hypoperfusion is perceived by baroreceptors, causing sympathetic and neurohormonal constrictive reflexes. The RAAS cascade then increases salt and water retention, all of which cause volume overload and blood backup in the heart, yielding pulmonary edema, hypoxemia, and worsening ischemia. Systemic inflammatory response and end-organ dysfunction result from and contribute to the larger spiral. Events best targeted by interventions are marked by white text on purple headings. This figure cohesively combines gross and cellular pathology in a schematic format using original composition and hierarchy of arrows, information, and imagery to portray CS pathophysiology as a cyclical interplay of events and interactions. For those with vision impairments, contrast, line weight, and size are used such that text and arrow hierarchy do not rely on color. Most text is black on a light background, whose contrast ratios are higher than the minimum 7:1 ratio for accessibility. A background woman figure represents systemic inflammation and organ damage, as women are more susceptible to CS.