Cardiologic problems in the post acute ventilated patient.

Chronically critically ill patients who develop acute respiratory failure commonly have complicating cardiac pathology that may or may not be evident at initial evaluation. The acute coronary syndromes should be excluded in all patients presenting with respiratory failure. Cardiac rhythm disturbances are common and should be actively investigated and treated in all critically ill patients. Heart failure is common in the chronically critically ill patient but usually responds to early diagnosis and prompt treatment. Finally, cardiogenic shock carries a poor prognosis in most patient subsets except when it is caused by cardiac tamponade. The intensivist must be vigilant for cardiac pathology complicating the recovery of patients with acute respiratory illness and initiate the search for correctable problems that may precipitate further episodes of respiratory insufficiency.