In the setting of CS, classic ACS symptoms and signs are combined with altered mental status, hypotension, arrhyth mia, diminished pulses, dyspnea, peripheral edema, jugular venous distention, and orthopnea . These features reflect an infarction involving >40% of the left ventricle,17 and can occur in the setting of an acute infarct superimposed on an old MI or a new massive MI
