By Judith S. Hochman, E. Magnus Ohman MD
* A accomplished resource of knowledge at the administration of cardiogenic surprise * a part of the AHA scientific sequence released along side the yank center organization * makes a speciality of high-interest and rising issues in heart problems exact to cardiologists and different healthcare companies * a great tool for investigating, comparing and treating essentially the most very important lingering demanding situations in acute cardiovascular care
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Extra info for Cardiogenic Shock
We will then discuss myocardial pathology, including mechanisms of expansion of myocardial infarction, consequences of remote ischemia, diastolic abnormalities, and the contribution of valvular dysfunction. We will also consider cellular pathophysiology in cardiogenic shock. Finally, mechanisms of reversible myocardial dysfunction will be discussed, since the potential for reversibility provides the rationale for both reperfusion and supportive therapies in cardiogenic shock. Systemic effects Classic paradigm Cardiac dysfunction in patients with cardiogenic shock is usually initiated by an extensive myocardial infarction, although a smaller infarction in a patient with P1: SFK/UKS 9781405179263 P2: SFK/UKS QC: SFK/UKS BLBK160-Hochman T1: SFK February 13, 2009 11:24 28 Cardiogenic Shock MYOCARDIAL DYSFUNCTION DIASTOLIC SYSTOLIC ↓ Cardiac output ↓ Stroke volume ↓ Systemic perfusion ↑ LVEDP Pulmonary congestion Hypotension ↓ Coronary perfusion pressure Compensatory vasoconstriction; Fluid retention Hypoxemia ISCHEMIA PROGRESSIVE MYOCARDIAL DYSFUNCTION DEATH Fig.
Am J Cardiol 2001;87(10):1200–3, A1207. 35. Jeger RV, Harkness SM, Ramanathan K, et al. Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry. Eur Heart J 2006;27(6):664–70. 36. Hands ME, Rutherford JD, Muller JE, et al. The in-hospital development of cardiogenic shock after myocardial infarction: incidence, predictors of occurrence, outcome and prognostic factors. The MILIS Study Group. J Am Coll Cardiol 1989;14(1):40–6, discussion 47–8.
The hemodynamic measurements with greatest prognostic value appear to be cardiac output  or those measurements that incorporate cardiac output with systolic blood pressure, including stroke work  or cardiac power . In the SHOCK trial, the strongest association with in-hospital mortality was found for cardiac power. Cardiac power was calculated as mean arterial pressure × cardiac output/451 . Also in SHOCK, the presence of cardiogenic shock on admission appeared to be an independent predictor of inhospital mortality as compared with cardiogenic shock that developed during hospitalization (68% vs.