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[Cardiogenic shock]
O Bertel1, E Straumann, N Balmelli
1Medizinische Klinik, Stadtspital Triemli, Zürich.
Insights
Cardiogenic shock (CS) has a high mortality rate. Early invasive management, including revascularization and circulatory support, improves survival for myocardial infarction patients.
Area of Science:
- Cardiology
- Critical Care Medicine
Context:
- Cardiogenic shock (CS) presents with severe hypotension and organ hypoperfusion.
- High mortality rates (80-100%) persist without timely intervention for underlying causes.
Purpose:
- To outline the critical management strategies for cardiogenic shock.
- To emphasize the benefits of early invasive interventions in specific CS etiologies.
Summary:
- CS is frequently caused by acute myocardial infarction, valvular incompetence, or cardiomyopathies.
- While some conditions benefit from conservative treatment, others necessitate urgent cardiac surgery or circulatory assistance.
- For CS post-myocardial infarction, early revascularization and intra-aortic balloon pumping offer improved survival over medical therapy alone.
Impact:
- This approach enhances survival rates for CS patients, particularly those with myocardial infarction.
- Facilitates transfer for advanced interventions, improving outcomes for patients in non-specialized centers.
Abstract:
Cardiogenic shock (CS), defined as forward failure combined with systolic blood pressure < 90 mm Hg and reduced organ perfusion despite adequate volume loading, still has a grim prognosis with mortality rates of 80-100% if the causes are left untreated. The most frequent conditions underlying CS are acute myocardial infarction, acute and severe aortic or mitral incompetence, rapidly progressive dilatative cardiomyopathy and hypertrophic obstructive cardiomyopathy. Whereas correct conservative management by drugs and pacing may be life saving in the latter, the other conditions require early invasive management. Indications for cardiac surgery and circulatory assistance are given for mechanical complications leading to CS. In CS complicating myocardial infarction, comprehensive management with early invasive revascularization and intraaortic balloon pumping may result in improved survival compared with the disappointing outcome of medical treatment, including fibrinolysis. This strategy can be offered to the majority of infarct patients in CS, who are primarily admitted to hospitals not equipped for interventional cardiology or cardiac surgery. Between-hospital transfer of these patients for PTCA (or surgery) and advanced intensive care has been shown to be feasible and safe.