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Cardiogenic Shock in Patients with Advanced Chronic Heart Failure

Cesar Y Guerrero-Miranda1, Shelley A Hall1

  • 1BAYLOR SCOTT & WHITE RESEARCH INSTITUTE, DALLAS, TEXAS; BAYLOR UNIVERSITY MEDICAL CENTER, DALLAS, TEXAS; TEXAS A&M HEALTH SCIENCE CENTER, DALLAS, TEXAS.

Methodist Debakey Cardiovascular Journal
|April 14, 2020
PubMed

Insights

Managing cardiogenic shock (CS) in advanced heart failure (HF) presents unique challenges. Early multidisciplinary assessment is crucial for timely intervention and advanced therapy candidacy in these complex patients.

Area of Science:

  • Cardiology
  • Critical Care Medicine

Background:

  • Patients with end-stage heart failure (HF) refractory to medical therapy present distinct challenges compared to those with cardiogenic shock (CS) from myocardial infarction.
  • Progression to refractory CS in advanced HF is linked to poor outcomes due to recognition, intervention, and salvage option difficulties.

Purpose of the Study:

  • To review the definition, phenotypes, and classification of CS in advanced HF patients.
  • To discuss the role of temporary mechanical circulatory support and the CS team in managing these complex cases.

Main Methods:

  • This review synthesizes current literature on CS in advanced HF.
  • Key aspects discussed include CS heterogeneity, diagnostic challenges, and treatment escalation strategies.

Main Results:

  • CS in advanced HF is heterogeneous with varied etiologies, onset, hemodynamics, and end-organ effects.
  • A universal definition for CS in this population is lacking, complicating management.
  • Blunted hemodynamic response is common due to prolonged compensatory mechanisms.

Conclusions:

  • Advanced HF patients in CS require a multidisciplinary team approach for timely assessment and escalation of care.
  • Evaluating candidacy for temporary mechanical circulatory support and advanced therapies is critical.

Keywords:
advanced heart failurecardiogenic shockend-stage heart failurestage D heart failure

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