Cardiogenic shock other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Syed Musadiq Ali M.B.B.S.[3]
Overview
The Swan-ganz catheter, right heart catheter or pulmonary artery catheter has been gradually replaced by echocardiography with color Doppler throughout the years, however, it is still common practice in some centers. It may be used for different situations, such as: confirming the diagnosis of cardiogenic shock following clinical evaluation, ensuring adequacy of filling pressures, establishing the relationship between these filling pressures and cardiac output as well as helping in possible adjustments in therapy. It is still a very important tool for the assessment of hemodynamic parameters, such as cardiac power and stroke work index, which are important data for short-term prognosis.It may also be helpful in distinguishing cardiogenic shock from septic shock and in optimizing the patient's left ventricular filling pressures. The presence of significant V waves (greatly exceeding the pulmonary capillary wedge pressure) on the pulmonary artery tracing suggests either acute mitral regurgitation or a ventricular septal defect. The revascularization procedure may consist of percutaneous coronary intervention procedure or coronary artery bypass graft surgery. Patients who have undergone reperfusion procedures with either percutaneous coronary intervention or fibrinolytic therapy, experiencing new symptoms, should also be evaluated for failure of the initial treatment.
Other Diagnostic Studies
Swan Ganz Catheter
- The Swan-ganz catheter, right heart catheter or pulmonary artery catheter has been gradually replaced by echocardiography with color Doppler throughout the years, however, it is still common practice in some centers.
- It may be used for different situations, such as: confirming the diagnosis of cardiogenic shock following clinical evaluation, ensuring adequacy of filling pressures, establishing the relationship between these filling pressures and cardiac output as well as helping in possible adjustments in therapy.[1]
- It is still a very important tool for the assessment of hemodynamic parameters, such as cardiac power and stroke work index, which are important data for short-term prognosis.[2]
- It may also be helpful in distinguishing cardiogenic shock from septic shock and in optimizing the patient's left ventricular filling pressures.
- The presence of significant V waves (greatly exceeding the pulmonary capillary wedge pressure) on the pulmonary artery tracing suggests either acute mitral regurgitation or a ventricular septal defect.
- In cardiogenic shock complicating RV infarct, the PA catheter may help in the diagnosis, when the following criteria are found:[3][4][5][6]
- In cardiogenic shock complicating acute MR, PA catheter may reveal:[3][7]
- large V wave in PCWP tracing
- severity of MR, given by left ventriculogram carried out during cardiac catheterization
- In cardiogenic shock complicating VSR, PA catheter may reveal:[3][8]
- large V wave in PCWP tracing
- confirmation of diagnosis
- calculation of shunt fraction
- rise of ≥8% of oxygen saturation between RA and PA
- location and size of VSR, given by left ventriculogram, carried out during cardiac catheterization
- In cardiogenic shock complicating free wall rupture and tamponade, PA catheter may reveal:[3]
- This technique is recommended for MI patients who are severely hypotensive, however, several centers are gradually switching to a less invasive approach, managing cardiogenic shock patients by their clinical status, complemented by echocardiography, instead of using the PA catheter. [1][9]
Coronary Angiography
- This method is indicated for patients with cardiogenic shock in whom myocardial infarction is suspected and that have indication for revascularization procedures.
- The revascularization procedure may consist of percutaneous coronary intervention procedure or coronary artery bypass graft surgery.[10] Patients who have undergone reperfusion procedures with either percutaneous coronary intervention or fibrinolytic therapy, experiencing new symptoms, should also be evaluated for failure of the initial treatment.
Biopsy
In case of suspected cardiomyopathy a biopsy of heart muscle may be of benefit in establishing a definitive diagnosis.
References
- ↑ 1.0 1.1 Reynolds, H. R.; Hochman, J. S. (2008). "Cardiogenic Shock: Current Concepts and Improving Outcomes". Circulation. 117 (5): 686–697. doi:10.1161/CIRCULATIONAHA.106.613596. ISSN 0009-7322.
- ↑ Fincke R, Hochman JS, Lowe AM, Menon V, Slater JN, Webb JG; et al. (2004). "Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: a report from the SHOCK trial registry". J Am Coll Cardiol. 44 (2): 340–8. doi:10.1016/j.jacc.2004.03.060. PMID 15261929.
- ↑ 3.0 3.1 3.2 3.3 Ng, R.; Yeghiazarians, Y. (2011). "Post Myocardial Infarction Cardiogenic Shock: A Review of Current Therapies". Journal of Intensive Care Medicine. 28 (3): 151–165. doi:10.1177/0885066611411407. ISSN 0885-0666.
- ↑ Topol, Eric (2007). Textbook of cardiovascular medicine. Philadelphia: Lippincott Williams & Wilkins. ISBN 0781770122.
- ↑ Dell'Italia LJ, Starling MR, Crawford MH, Boros BL, Chaudhuri TK, O'Rourke RA (1984). "Right ventricular infarction: identification by hemodynamic measurements before and after volume loading and correlation with noninvasive techniques". J Am Coll Cardiol. 4 (5): 931–9. PMID 6092446.
- ↑ Kinch JW, Ryan TJ (1994). "Right ventricular infarction". N Engl J Med. 330 (17): 1211–7. doi:10.1056/NEJM199404283301707. PMID 8139631.
- ↑ Reeder GS (1995). "Identification and treatment of complications of myocardial infarction". Mayo Clin Proc. 70 (9): 880–4. doi:10.1016/S0025-6196(11)63946-3. PMID 7643642.
- ↑ Hillis LD, Firth BG, Winniford MD (1986). "Variability of right-sided cardiac oxygen saturations in adults with and without left-to-right intracardiac shunting". Am J Cardiol. 58 (1): 129–32. PMID 3728312.
- ↑ Antman, E. M. (2004). "ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)". Circulation. 110 (5): 588–636. doi:10.1161/01.CIR.0000134791.68010.FA. ISSN 0009-7322.
- ↑ Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M; et al. (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)". Circulation. 110 (5): 588–636. doi:10.1161/01.CIR.0000134791.68010.FA. PMID 15289388.