**7. Treatment considerations in non-ACS related CS**

The mechanical complications of AMI such as acute MR, papillary muscle rupture, ventricular septal rupture and LV free wall rupture are catastrophic, and carry very high mortality and are surgical emergencies. IABP helps stabilize these patients, especially acute MR patients, and the other MCS devices can be used in these situations as well.

RV failure resulting in CS also carries high mortality; ECMO or RVAD might be especially helpful in this situation. In CS secondary to massive pulmonary embolism, fibrinolysis (or mechanical thrombectomy) might be helpful, and in RV failure secondary to severe pulmonary arterial hypertension, the use of pulmonary hypertension (PH) specific therapy might provide improvement in the PA pressures and RV function.

The treatment considerations in acute decompensated heart failure (ADHF) and end stage cardiomyopathy are those of the heart failure guidelines [20], and the above-mentioned MCS devices can be used interchangeably.

In most patients with myocarditis, the course is usually self-limiting and presents with acute heart failure; on the other hand, fulminant myocarditis will present with acute severe heart failure and even CS. Close to 90% of patients with fulminant myocarditis will have full recovery with minimal long-term sequelae if recognized early. The treatment of CS secondary to fulminant myocarditis includes hemodynamic support with pharmacotherapy or MCS devices, along with high dose steroids with or without immunosuppressants if giant cell myocarditis is diagnosed [58].
