Cardiogenic shock

Česká verzia

Authors: J. Pařenica
Published in the journal: Kardiol Rev Int Med 2011, 13(1): 20-23
Category: From Hypertension to Heart Failure

Summary

The most common cause of cardiogenic shock is acute myocardial infarction. Severe left ventricular dysfunction, systemic inflammatory response syndrome, mechanical complications, impairment of the right ventricle and iatrogenic injury may contribute to the development of cardiogenic shock. Emergent coronary revascularization should be performed on the infarct-related artery and on other critical narrowings of coronary arteries. The elementary mechanical support for patients in cardiogenic shock is intraaortic balloon counterpulsation. Haemodynamic monitoring is used to ensure the optimal filling of the left ventricle (PCWP 18–22 mmHg). In the event that hypotension is resistant to catecholamines, where hypotension persists despite a combination of mechanical support, norepinephrine, dobutamine and adrenaline, the administration of terlipressin and substitute doses of corticosteroids may be considered as pharmacological rescue therapy. When renal failure occurs, the early initiation of continuous veno-venous hemofiltration is indicated. This can lead to a reduced need for vasosuppressants.

Keywords:
cardiogenic shock – myocardial infarction – IABP – hypotension resistant to catecholamines

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