Cardiac Resynchronization Therapy in Cardiogenic Shock: A Case-Based Discussion
Francisco J Somoza-Cano1, Juan F Toledo2, Ramses Amaya-Handal3
1Internal Medicine, St. Vincent Charity Medical Center, Cleveland, USA.
Cureus
|October 25, 2021
Summary
Cardiac resynchronization therapy (CRT) can improve left ventricular ejection fraction (LVEF) in acute heart failure. This case study shows CRT as a viable option for cardiogenic shock with a wide QRS.
Area of Science:
- Cardiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is established for heart failure, but its role in acute settings is debated.
- Current guidelines support CRT for chronic heart failure, yet evidence in acute heart failure syndromes (AHFSs) is limited.
Observation:
- A 55-year-old male with alcohol-induced cardiomyopathy presented with new left bundle branch block, QRS duration of 154 ms, and cardiogenic shock (CS).
- Optimal medical management failed to improve the patient's condition.
Findings:
- CRT was implemented as a last resort, leading to a satisfactory clinical course and improved left ventricular ejection fraction (LVEF).
- At four-month follow-up, the patient demonstrated further LVEF augmentation, improved functional class, and no recurrent acute heart failure events.
Implications:
- This case suggests CRT may be a potential therapeutic option for cardiogenic shock patients with a wide QRS.
- Further prospective trials are needed to clarify the utility of CRT in acute heart failure syndromes (AHFSs).
Related Concept Videos
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
113
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
113
01:30Cardiomyopathy II: Dilated Cardiomyopathy
73
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
73
01:25Dysrhythmias VI: Management of Dysrhythmias
159
Dysrhythmia management involves a multifaceted approach, incorporating pharmacological treatments, medical procedures, surgical interventions, lifestyle modifications, and patient education.Pharmacological ManagementAntiarrhythmic Drugs:Class I (Sodium Channel Blockers): This class includes quinidine and procainamide, which reduce the speed of impulse conduction in the heart, stabilize the cardiac membrane, and control arrhythmias. Quinidine and procainamide are Class IA agents that prolong the...
159
01:29Cardiomyopathy V: Interprofessional Care
65
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
65
01:23Cardiopulmonary Resuscitation III: AED Use
126
Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
126
01:22Heart Failure VI: Adjunct Therapies
53
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
53