Cardiogenic shock risk factors: Difference between revisions

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__NOTOC__
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{{Cardiogenic shock}}
{{Cardiogenic shock}}
{{CMG}}; {{AE}} {{JS}}
{{CMG}}; {{AE}} {{JS}} {{sali}}


==Overview==
==Overview==
The identification of high-risk groups for developing cardiogenic shock, particularly in [[ACS]] patients (since this is the most common cause of this type of [[shock]]), and its promoting factors is mandatory for the improvement of the [[survival rate]] of these [[patients]] by providing adequate therapeutic measures and avoiding others which might otherwise lead to [[iatrogenic]] [[shock]].<ref>{{Cite book  | last1 = Hasdai | first1 = David. | title = Cardiogenic shock : diagnosis and treatmen | date = 2002 | publisher = Humana Press | location = Totowa, N.J. | isbn = 1-58829-025-5 | pages =  }}</ref>
The identification of high-risk groups for developing cardiogenic shock and its promoting factors is mandatory for the improvement of the [[survival rate]] of these [[patients]]. This will facilitate the providing of adequate therapeutic measures and the avoidance of others which would otherwise lead to [[iatrogenic]] [[shock]]. Considering that the most common cause of cardiogenic shock is [[acute coronary syndrome]], either with or without persistent [[ST elevation myocardial infarction|ST-segment elevation]], these [[patients]] are at higher risk and will benefit highly from these measures.


Several triggers have been associated with an increased risk of developing cardiogenic shock. Advanced age and [[MI]] are among the most common predisposing risk factors.
==Risk Factors==
===Common Risk Factors===
According to several studies and considering that ''[[left ventricular dysfunction]]'' is the most common cause of developing [[cardiogenic shock]] following [[myocardial infarction]], the most common [[risk factors]] for this condition include:


==Risk Factors==
*Older age (> 65 years)<ref name="HandsRutherford1989">{{cite journal|last1=Hands|first1=Mark E.|last2=Rutherford|first2=John D.|last3=Muller|first3=James E.|last4=Davies|first4=Glenn|last5=Stone|first5=Peter H.|last6=Parker|first6=Corette|last7=Braunwald|first7=Eugene|title=The in-hospital development of cardiogenic shock after myocardial infarction: Incidence, predictors of occurrence, outcome and prognostic factors|journal=Journal of the American College of Cardiology|volume=14|issue=1|year=1989|pages=40–46|issn=07351097|doi=10.1016/0735-1097(89)90051-X}}</ref> For every 10 years of age, the risk is 47% greater.<ref name="pmid10636271">{{cite journal| author=Hasdai D, Califf RM, Thompson TD, Hochman JS, Ohman EM, Pfisterer M et al.| title=Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction. | journal=J Am Coll Cardiol | year= 2000 | volume= 35 | issue= 1 | pages= 136-43 | pmid=10636271 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10636271  }} </ref>
Risk factors for the development of [[cardiogenic shock]] include:
*Female sex, although some studies do not consider female sex as an independent predictor of poor outcome<ref name="pmid8452150">{{cite journal| author=Leor J, Goldbourt U, Reicher-Reiss H, Kaplinsky E, Behar S| title=Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: incidence, risk factors, and outcome. SPRINT Study Group. | journal=Am J Med | year= 1993 | volume= 94 | issue= 3 | pages= 265-73 | pmid=8452150 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8452150  }} </ref>
*Prior [[myocardial infarction]] ([[MI]])<ref name="pmid8452150">{{cite journal| author=Leor J, Goldbourt U, Reicher-Reiss H, Kaplinsky E, Behar S| title=Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: incidence, risk factors, and outcome. SPRINT Study Group. | journal=Am J Med | year= 1993 | volume= 94 | issue= 3 | pages= 265-73 | pmid=8452150 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8452150  }} </ref>
*Prior [[angina]]<ref name="pmid8452150">{{cite journal| author=Leor J, Goldbourt U, Reicher-Reiss H, Kaplinsky E, Behar S| title=Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: incidence, risk factors, and outcome. SPRINT Study Group. | journal=Am J Med | year= 1993 | volume= 94 | issue= 3 | pages= 265-73 | pmid=8452150 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8452150  }} </ref>
*[[Peripheral vascular disease]]<ref name="pmid8452150">{{cite journal| author=Leor J, Goldbourt U, Reicher-Reiss H, Kaplinsky E, Behar S| title=Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: incidence, risk factors, and outcome. SPRINT Study Group. | journal=Am J Med | year= 1993 | volume= 94 | issue= 3 | pages= 265-73 | pmid=8452150 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8452150  }} </ref>
*[[Left ventricular ejection fraction]] < 35%<ref name="HandsRutherford1989">{{cite journal|last1=Hands|first1=Mark E.|last2=Rutherford|first2=John D.|last3=Muller|first3=James E.|last4=Davies|first4=Glenn|last5=Stone|first5=Peter H.|last6=Parker|first6=Corette|last7=Braunwald|first7=Eugene|title=The in-hospital development of cardiogenic shock after myocardial infarction: Incidence, predictors of occurrence, outcome and prognostic factors|journal=Journal of the American College of Cardiology|volume=14|issue=1|year=1989|pages=40–46|issn=07351097|doi=10.1016/0735-1097(89)90051-X}}</ref>
*Moderate to severe [[mitral regurgitation]]<ref name="pmid12538428">{{cite journal| author=Picard MH, Davidoff R, Sleeper LA, Mendes LA, Thompson CR, Dzavik V et al.| title=Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. | journal=Circulation | year= 2003 | volume= 107 | issue= 2 | pages= 279-84 | pmid=12538428 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12538428  }} </ref>
*Larger [[infarct]] area (estimated by serial cardiac markers)<ref name="HandsRutherford1989">{{cite journal|last1=Hands|first1=Mark E.|last2=Rutherford|first2=John D.|last3=Muller|first3=James E.|last4=Davies|first4=Glenn|last5=Stone|first5=Peter H.|last6=Parker|first6=Corette|last7=Braunwald|first7=Eugene|title=The in-hospital development of cardiogenic shock after myocardial infarction: Incidence, predictors of occurrence, outcome and prognostic factors|journal=Journal of the American College of Cardiology|volume=14|issue=1|year=1989|pages=40–46|issn=07351097|doi=10.1016/0735-1097(89)90051-X}}</ref>
*[[Diabetes mellitus]]<ref name="HandsRutherford1989">{{cite journal|last1=Hands|first1=Mark E.|last2=Rutherford|first2=John D.|last3=Muller|first3=James E.|last4=Davies|first4=Glenn|last5=Stone|first5=Peter H.|last6=Parker|first6=Corette|last7=Braunwald|first7=Eugene|title=The in-hospital development of cardiogenic shock after myocardial infarction: Incidence, predictors of occurrence, outcome and prognostic factors|journal=Journal of the American College of Cardiology|volume=14|issue=1|year=1989|pages=40–46|issn=07351097|doi=10.1016/0735-1097(89)90051-X}}</ref>
*[[Impaired fasting glucose]]<ref name="pmid14984919">{{cite journal| author=Zeller M, Cottin Y, Brindisi MC, Dentan G, Laurent Y, Janin-Manificat L et al.| title=Impaired fasting glucose and cardiogenic shock in patients with acute myocardial infarction. | journal=Eur Heart J | year= 2004 | volume= 25 | issue= 4 | pages= 308-12 | pmid=14984919 | doi=10.1016/j.ehj.2003.12.014 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14984919  }} </ref>
*[[ST]] elevation<ref name="pmid9459474">{{cite journal| author=Hathaway WR, Peterson ED, Wagner GS, Granger CB, Zabel KM, Pieper KS et al.| title=Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries. | journal=JAMA | year= 1998 | volume= 279 | issue= 5 | pages= 387-91 | pmid=9459474 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9459474  }} </ref>
*[[ST]] depression<ref name="pmid9459474">{{cite journal| author=Hathaway WR, Peterson ED, Wagner GS, Granger CB, Zabel KM, Pieper KS et al.| title=Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries. | journal=JAMA | year= 1998 | volume= 279 | issue= 5 | pages= 387-91 | pmid=9459474 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9459474  }} </ref>
*[[Q wave]]s ([[EKG]] evidence of prior [[myocardial infarction]])<ref name="pmid9459474">{{cite journal| author=Hathaway WR, Peterson ED, Wagner GS, Granger CB, Zabel KM, Pieper KS et al.| title=Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries. | journal=JAMA | year= 1998 | volume= 279 | issue= 5 | pages= 387-91 | pmid=9459474 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9459474  }} </ref>
*According to the analysis of PURSUIT trial database<ref name="pmid10987585">{{cite journal| author=Hasdai D, Harrington RA, Hochman JS, Califf RM, Battler A, Box JW et al.| title=Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation. | journal=J Am Coll Cardiol | year= 2000 | volume= 36 | issue= 3 | pages= 685-92 | pmid=10987585 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10987585  }} </ref> in [[non-ST-segment elevation myocardial infarction|Non-ST-segment elevation myocardial infarction]] [[patients]] who received [[eptifibatide]] saw their 30-day mortality risk reduced by 50%. In this trial, risk factors for development of cardiogenic shock like age and presence of [[ST]] depression in the initial [[EKG]], in [[patients]] with [[non-ST-segment elevation myocardial infarction|Non-ST-segment elevation myocardial infarction]], was also noted.
*[[Left bundle branch block]]<ref name="pmid9426026">{{cite journal| author=Sgarbossa EB, Pinski SL, Topol EJ, Califf RM, Barbagelata A, Goodman SG et al.| title=Acute myocardial infarction and complete bundle branch block at hospital admission: clinical characteristics and outcome in the thrombolytic era. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA [tissue-type plasminogen activator] for Occluded Coronary Arteries. | journal=J Am Coll Cardiol | year= 1998 | volume= 31 | issue= 1 | pages= 105-10 | pmid=9426026 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9426026  }} </ref>
*History of [[hypertension]]<ref name="ReynoldsHochman2008">{{cite journal|last1=Reynolds|first1=H. R.|last2=Hochman|first2=J. S.|title=Cardiogenic Shock: Current Concepts and Improving Outcomes|journal=Circulation|volume=117|issue=5|year=2008|pages=686–697|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.613596}}</ref><ref name="HasdaiCaliff2000">{{cite journal|last1=Hasdai|first1=David|last2=Califf|first2=Robert M.|last3=Thompson|first3=Trevor D.|last4=Hochman|first4=Judith S.|last5=Ohman|first5=E.Magnus|last6=Pfisterer|first6=Matthias|last7=Bates|first7=Eric R.|last8=Vahanian|first8=Alec|last9=Armstrong|first9=Paul W.|last10=Criger|first10=Douglas A.|last11=Topol|first11=Eric J.|last12=Holmes|first12=David R.|title=Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction|journal=Journal of the American College of Cardiology|volume=35|issue=1|year=2000|pages=136–143|issn=07351097|doi=10.1016/S0735-1097(99)00508-2}}</ref>
*[[Heart failure]] on admission<ref name="ReynoldsHochman2008">{{cite journal|last1=Reynolds|first1=H. R.|last2=Hochman|first2=J. S.|title=Cardiogenic Shock: Current Concepts and Improving Outcomes|journal=Circulation|volume=117|issue=5|year=2008|pages=686–697|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.613596}}</ref><ref name="HasdaiCaliff2000">{{cite journal|last1=Hasdai|first1=David|last2=Califf|first2=Robert M.|last3=Thompson|first3=Trevor D.|last4=Hochman|first4=Judith S.|last5=Ohman|first5=E.Magnus|last6=Pfisterer|first6=Matthias|last7=Bates|first7=Eric R.|last8=Vahanian|first8=Alec|last9=Armstrong|first9=Paul W.|last10=Criger|first10=Douglas A.|last11=Topol|first11=Eric J.|last12=Holmes|first12=David R.|title=Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction|journal=Journal of the American College of Cardiology|volume=35|issue=1|year=2000|pages=136–143|issn=07351097|doi=10.1016/S0735-1097(99)00508-2}}</ref>
*[[Multivessel coronary artery disease]]<ref name="ReynoldsHochman2008">{{cite journal|last1=Reynolds|first1=H. R.|last2=Hochman|first2=J. S.|title=Cardiogenic Shock: Current Concepts and Improving Outcomes|journal=Circulation|volume=117|issue=5|year=2008|pages=686–697|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.613596}}</ref><ref name="HasdaiCaliff2000">{{cite journal|last1=Hasdai|first1=David|last2=Califf|first2=Robert M.|last3=Thompson|first3=Trevor D.|last4=Hochman|first4=Judith S.|last5=Ohman|first5=E.Magnus|last6=Pfisterer|first6=Matthias|last7=Bates|first7=Eric R.|last8=Vahanian|first8=Alec|last9=Armstrong|first9=Paul W.|last10=Criger|first10=Douglas A.|last11=Topol|first11=Eric J.|last12=Holmes|first12=David R.|title=Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction|journal=Journal of the American College of Cardiology|volume=35|issue=1|year=2000|pages=136–143|issn=07351097|doi=10.1016/S0735-1097(99)00508-2}}</ref>
*Early use of [[beta blockers]] in large [[infarct|infarcts]]<ref name="ReynoldsHochman2008">{{cite journal|last1=Reynolds|first1=H. R.|last2=Hochman|first2=J. S.|title=Cardiogenic Shock: Current Concepts and Improving Outcomes|journal=Circulation|volume=117|issue=5|year=2008|pages=686–697|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.613596}}</ref><ref name="HasdaiCaliff2000">{{cite journal|last1=Hasdai|first1=David|last2=Califf|first2=Robert M.|last3=Thompson|first3=Trevor D.|last4=Hochman|first4=Judith S.|last5=Ohman|first5=E.Magnus|last6=Pfisterer|first6=Matthias|last7=Bates|first7=Eric R.|last8=Vahanian|first8=Alec|last9=Armstrong|first9=Paul W.|last10=Criger|first10=Douglas A.|last11=Topol|first11=Eric J.|last12=Holmes|first12=David R.|title=Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction|journal=Journal of the American College of Cardiology|volume=35|issue=1|year=2000|pages=136–143|issn=07351097|doi=10.1016/S0735-1097(99)00508-2}}</ref>
*In certain cases, excessive use of [[diuretics]] causing depletion of intravascular volume<ref>{{Cite book  | last1 = Hasdai | first1 = David. | title = Cardiogenic shock : diagnosis and treatmen | date = 2002 | publisher = Humana Press | location = Totowa, N.J. | isbn = 1-58829-025-5 | pages =  }}</ref>
*[[Systolic blood pressure]] < 120 mm Hg<ref name="ReynoldsHochman2008">{{cite journal|last1=Reynolds|first1=H. R.|last2=Hochman|first2=J. S.|title=Cardiogenic Shock: Current Concepts and Improving Outcomes|journal=Circulation|volume=117|issue=5|year=2008|pages=686–697|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.613596}}</ref><ref name="HasdaiCaliff2000">{{cite journal|last1=Hasdai|first1=David|last2=Califf|first2=Robert M.|last3=Thompson|first3=Trevor D.|last4=Hochman|first4=Judith S.|last5=Ohman|first5=E.Magnus|last6=Pfisterer|first6=Matthias|last7=Bates|first7=Eric R.|last8=Vahanian|first8=Alec|last9=Armstrong|first9=Paul W.|last10=Criger|first10=Douglas A.|last11=Topol|first11=Eric J.|last12=Holmes|first12=David R.|title=Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction|journal=Journal of the American College of Cardiology|volume=35|issue=1|year=2000|pages=136–143|issn=07351097|doi=10.1016/S0735-1097(99)00508-2}}</ref>
*[[Sinus tachycardia]]<ref name="ReynoldsHochman2008">{{cite journal|last1=Reynolds|first1=H. R.|last2=Hochman|first2=J. S.|title=Cardiogenic Shock: Current Concepts and Improving Outcomes|journal=Circulation|volume=117|issue=5|year=2008|pages=686–697|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.613596}}</ref><ref name="HasdaiCaliff2000">{{cite journal|last1=Hasdai|first1=David|last2=Califf|first2=Robert M.|last3=Thompson|first3=Trevor D.|last4=Hochman|first4=Judith S.|last5=Ohman|first5=E.Magnus|last6=Pfisterer|first6=Matthias|last7=Bates|first7=Eric R.|last8=Vahanian|first8=Alec|last9=Armstrong|first9=Paul W.|last10=Criger|first10=Douglas A.|last11=Topol|first11=Eric J.|last12=Holmes|first12=David R.|title=Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction|journal=Journal of the American College of Cardiology|volume=35|issue=1|year=2000|pages=136–143|issn=07351097|doi=10.1016/S0735-1097(99)00508-2}}</ref>
*[[Heart rate]] < 60 bpm<ref>{{Cite journal  | last1 = Antman | first1 = EM. | last2 = Hand | first2 = M. | last3 = Armstrong | first3 = PW. | last4 = Bates | first4 = ER. | last5 = Green | first5 = LA. | last6 = Halasyamani | first6 = LK. | last7 = Hochman | first7 = JS. | last8 = Krumholz | first8 = HM. | last9 = Lamas | first9 = GA. | title = 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal = J Am Coll Cardiol | volume = 51 | issue = 2 | pages = 210-47 | month = Jan | year = 2008 | doi = 10.1016/j.jacc.2007.10.001 | PMID = 18191746 }}</ref>
*[[Physical examination|Physical findings]] of [[hypoperfusion]] at time of [[diagnosis]], such as [[altered state of consciousness]] or [[cold and clammy skin]]<ref name="pmid10385759">{{cite journal| author=Hasdai D, Holmes DR, Califf RM, Thompson TD, Hochman JS, Pfisterer M et al.| title=Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO Investigators. Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries. | journal=Am Heart J | year= 1999 | volume= 138 | issue= 1 Pt 1 | pages= 21-31 | pmid=10385759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10385759  }} </ref>
*[[Oliguria]]<ref name="pmid10385759">{{cite journal| author=Hasdai D, Holmes DR, Califf RM, Thompson TD, Hochman JS, Pfisterer M et al.| title=Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO Investigators. Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries. | journal=Am Heart J | year= 1999 | volume= 138 | issue= 1 Pt 1 | pages= 21-31 | pmid=10385759 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10385759  }} </ref>
*Cardiogenic shock on admission<ref name="pmid16423873">{{cite journal| author=Jeger RV, Harkness SM, Ramanathan K, Buller CE, Pfisterer ME, Sleeper LA et al.| title=Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 6 | pages= 664-70 | pmid=16423873 | doi=10.1093/eurheartj/ehi729 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16423873  }} </ref>
*Timespan between [[symptom]] onset and when [[reperfusion]] is restored<ref name="pmid16707549">{{cite journal| author=Ortolani P, Marzocchi A, Marrozzini C, Palmerini T, Saia F, Serantoni C et al.| title=Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 13 | pages= 1550-7 | pmid=16707549 | doi=10.1093/eurheartj/ehl006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16707549  }} </ref>


* Elderly (age >70 yrs)
===Specific Risk Factors===
* Prior [[myocardial infarction]] ([[MI]])
According to the etiology of the [[shock]] post-[[myocardial infarction]], the different risk factors may have different importances in each cause:<ref name="NgYeghiazarians2011">{{cite journal|last1=Ng|first1=R.|last2=Yeghiazarians|first2=Y.|title=Post Myocardial Infarction Cardiogenic Shock: A Review of Current Therapies|journal=Journal of Intensive Care Medicine|volume=28|issue=3|year=2011|pages=151–165|issn=0885-0666|doi=10.1177/0885066611411407}}</ref>
* [[Diabetes]]
:*'''Right Ventricular Infarction'''
* Anterior infarction
::*Younger age
* Left main disease
::*Generally no history of previous [[MI]]
* 3 vessel disease
::*Generally single-vessel [[coronary disease]]
* Early use of [[beta blockers]] in large infarcts
::*Less likely anterior wall [[myocardial infarction]]
* Systolic blood pressure < 120 mm Hg
::*Volume overloading<ref>{{Cite book  | last1 = Hasdai | first1 = David. | title = Cardiogenic shock : diagnosis and treatmen | date = 2002 | publisher = Humana Press | location = Totowa, N.J. | isbn = 1-58829-025-5 | pages =  }}</ref><ref name="BrookesRavn1999">{{cite journal|last1=Brookes|first1=C.|last2=Ravn|first2=H.|last3=White|first3=P.|last4=Moeldrup|first4=U.|last5=Oldershaw|first5=P.|last6=Redington|first6=A.|title=Acute Right Ventricular Dilatation in Response to Ischemia Significantly Impairs Left Ventricular Systolic Performance|journal=Circulation|volume=100|issue=7|year=1999|pages=761–767|issn=0009-7322|doi=10.1161/01.CIR.100.7.761}}</ref>
* Sinus tachycardia > 110 bpm
:*'''Acute Mitral Regurgitation'''
* Heart rate < 60 bpm<ref>{{Cite journal | last1 = Antman | first1 = EM. | last2 = Hand | first2 = M. | last3 = Armstrong | first3 = PW. | last4 = Bates | first4 = ER. | last5 = Green | first5 = LA. | last6 = Halasyamani | first6 = LK. | last7 = Hochman | first7 = JS. | last8 = Krumholz | first8 = HM. | last9 = Lamas | first9 = GA. | title = 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal = J Am Coll Cardiol | volume = 51 | issue = 2 | pages = 210-47 | month = Jan | year = 2008 | doi = 10.1016/j.jacc.2007.10.001 | PMID = 18191746 }}</ref>
::*Female gender
::*Older age
::*[[Diabetes mellitus]]
::*Underlying [[cerebrovascular disease]]
::*Common preexisting symptomatic [[coronary artery disease]]<ref name="pmid1596043">{{cite journal| author=Tcheng JE, Jackman JD, Nelson CL, Gardner LH, Smith LR, Rankin JS et al.| title=Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction. | journal=Ann Intern Med | year= 1992 | volume= 117 | issue= 1 | pages= 18-24 | pmid=1596043 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1596043  }} </ref>
:*'''Ventricular Septal Rupture'''
::*Male gender<ref name="pmid13302144">{{cite journal| author=SANDERS RJ, KERN WH, BLOUNT SG| title=Perforation of the interventricular septum complicating myocardial infarction; a report of eight cases, one with cardiac catheterization. | journal=Am Heart J | year= 1956 | volume= 51 | issue= 5 | pages= 736-48 | pmid=13302144 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13302144  }} </ref>
::*Mean age of presentation of 62.5 years<ref name="pmid2329817">{{cite journal| author=Skillington PD, Davies RH, Luff AJ, Williams JD, Dawkins KD, Conway N et al.| title=Surgical treatment for infarct-related ventricular septal defects. Improved early results combined with analysis of late functional status. | journal=J Thorac Cardiovasc Surg | year= 1990 | volume= 99 | issue= 5 | pages= 798-808 | pmid=2329817 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2329817  }} </ref>
::*Common history of [[myocardial infarction]]<ref name="pmid760447">{{cite journal| author=Hutchins GM| title=Rupture of the interventricular septum complicating myocardial infarction: pathological analysis of 10 patients with clinically diagnosed perforations. | journal=Am Heart J | year= 1979 | volume= 97 | issue= 2 | pages= 165-73 | pmid=760447 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=760447  }} </ref><ref name="pmid7114934">{{cite journal| author=Daggett WM, Buckley MJ, Akins CW, Leinbach RC, Gold HK, Block PC et al.| title=Improved results of surgical management of postinfarction ventricular septal rupture. | journal=Ann Surg | year= 1982 | volume= 196 | issue= 3 | pages= 269-77 | pmid=7114934 | doi= | pmc=PMC1352596 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7114934  }} </ref>
::*History of [[systemic hypertension]] prior to [[myocardial infarction]]<ref name="pmid3052010">{{cite journal| author=Mann JM, Roberts WC| title=Rupture of the left ventricular free wall during acute myocardial infarction: analysis of 138 necropsy patients and comparison with 50 necropsy patients with acute myocardial infarction without rupture. | journal=Am J Cardiol | year= 1988 | volume= 62 | issue= 13 | pages= 847-59 | pmid=3052010 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3052010  }} </ref>
:*'''Free-Wall Rupture/Tamponade'''
::*Female gender
::*Age greater than 55 years<ref name="pmid331926">{{cite journal| author=Bates RJ, Beutler S, Resnekov L, Anagnostopoulos CE| title=Cardiac rupture--challenge in diagnosis and management. | journal=Am J Cardiol | year= 1977 | volume= 40 | issue= 3 | pages= 429-37 | pmid=331926 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=331926  }} </ref><ref name="pmid7677073">{{cite journal| author=Figueras J, Curos A, Cortadellas J, Sans M, Soler-Soler J| title=Relevance of electrocardiographic findings, heart failure, and infarct site in assessing risk and timing of left ventricular free wall rupture during acute myocardial infarction. | journal=Am J Cardiol | year= 1995 | volume= 76 | issue= 8 | pages= 543-7 | pmid=7677073 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7677073  }} </ref>
::*History of [[hypertension]]
::*Larger [[infarct]] area
::*Delayed or incomplete [[revascularization]]<ref name="pmid3052010">{{cite journal| author=Mann JM, Roberts WC| title=Rupture of the left ventricular free wall during acute myocardial infarction: analysis of 138 necropsy patients and comparison with 50 necropsy patients with acute myocardial infarction without rupture. | journal=Am J Cardiol | year= 1988 | volume= 62 | issue= 13 | pages= 847-59 | pmid=3052010 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3052010  }} </ref><ref name="pmid5380841">{{cite journal| author=Lewis AJ, Burchell HB, Titus JL| title=Clinical and pathologic features of postinfarction cardiac rupture. | journal=Am J Cardiol | year= 1969 | volume= 23 | issue= 1 | pages= 43-53 | pmid=5380841 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5380841  }} </ref><ref name="pmid4015910">{{cite journal| author=Dellborg M, Held P, Swedberg K, Vedin A| title=Rupture of the myocardium. Occurrence and risk factors. | journal=Br Heart J | year= 1985 | volume= 54 | issue= 1 | pages= 11-6 | pmid=4015910 | doi= | pmc=PMC481840 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4015910  }} </ref>
::*No history of [[myocardial infarction]]<ref name="pmid3052010">{{cite journal| author=Mann JM, Roberts WC| title=Rupture of the left ventricular free wall during acute myocardial infarction: analysis of 138 necropsy patients and comparison with 50 necropsy patients with acute myocardial infarction without rupture. | journal=Am J Cardiol | year= 1988 | volume= 62 | issue= 13 | pages= 847-59 | pmid=3052010 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3052010  }} </ref><ref name="pmid7677073">{{cite journal| author=Figueras J, Curos A, Cortadellas J, Sans M, Soler-Soler J| title=Relevance of electrocardiographic findings, heart failure, and infarct site in assessing risk and timing of left ventricular free wall rupture during acute myocardial infarction. | journal=Am J Cardiol | year= 1995 | volume= 76 | issue= 8 | pages= 543-7 | pmid=7677073 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7677073  }} </ref>
::*Single vessel [[coronary artery disease]]<ref name="pmid3052010">{{cite journal| author=Mann JM, Roberts WC| title=Rupture of the left ventricular free wall during acute myocardial infarction: analysis of 138 necropsy patients and comparison with 50 necropsy patients with acute myocardial infarction without rupture. | journal=Am J Cardiol | year= 1988 | volume= 62 | issue= 13 | pages= 847-59 | pmid=3052010 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3052010  }} </ref><ref name="pmid7677073">{{cite journal| author=Figueras J, Curos A, Cortadellas J, Sans M, Soler-Soler J| title=Relevance of electrocardiographic findings, heart failure, and infarct site in assessing risk and timing of left ventricular free wall rupture during acute myocardial infarction. | journal=Am J Cardiol | year= 1995 | volume= 76 | issue= 8 | pages= 543-7 | pmid=7677073 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7677073  }} </ref>


==References==
==References==

Latest revision as of 04:01, 3 January 2020

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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 identification of high-risk groups for developing cardiogenic shock and its promoting factors is mandatory for the improvement of the survival rate of these patients. This will facilitate the providing of adequate therapeutic measures and the avoidance of others which would otherwise lead to iatrogenic shock. Considering that the most common cause of cardiogenic shock is acute coronary syndrome, either with or without persistent ST-segment elevation, these patients are at higher risk and will benefit highly from these measures.

Risk Factors

Common Risk Factors

According to several studies and considering that left ventricular dysfunction is the most common cause of developing cardiogenic shock following myocardial infarction, the most common risk factors for this condition include:

Specific Risk Factors

According to the etiology of the shock post-myocardial infarction, the different risk factors may have different importances in each cause:[16]

  • Right Ventricular Infarction
  • Acute Mitral Regurgitation
  • Ventricular Septal Rupture
  • Free-Wall Rupture/Tamponade

References

  1. ↑ 1.0 1.1 1.2 1.3 Hands, Mark E.; Rutherford, John D.; Muller, James E.; Davies, Glenn; Stone, Peter H.; Parker, Corette; Braunwald, Eugene (1989). "The in-hospital development of cardiogenic shock after myocardial infarction: Incidence, predictors of occurrence, outcome and prognostic factors". Journal of the American College of Cardiology. 14 (1): 40–46. doi:10.1016/0735-1097(89)90051-X. ISSN 0735-1097.
  2. ↑ Hasdai D, Califf RM, Thompson TD, Hochman JS, Ohman EM, Pfisterer M; et al. (2000). "Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction". J Am Coll Cardiol. 35 (1): 136–43. PMID 10636271.
  3. ↑ 3.0 3.1 3.2 3.3 Leor J, Goldbourt U, Reicher-Reiss H, Kaplinsky E, Behar S (1993). "Cardiogenic shock complicating acute myocardial infarction in patients without heart failure on admission: incidence, risk factors, and outcome. SPRINT Study Group". Am J Med. 94 (3): 265–73. PMID 8452150.
  4. ↑ Picard MH, Davidoff R, Sleeper LA, Mendes LA, Thompson CR, Dzavik V; et al. (2003). "Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock". Circulation. 107 (2): 279–84. PMID 12538428.
  5. ↑ Zeller M, Cottin Y, Brindisi MC, Dentan G, Laurent Y, Janin-Manificat L; et al. (2004). "Impaired fasting glucose and cardiogenic shock in patients with acute myocardial infarction". Eur Heart J. 25 (4): 308–12. doi:10.1016/j.ehj.2003.12.014. PMID 14984919.
  6. ↑ 6.0 6.1 6.2 Hathaway WR, Peterson ED, Wagner GS, Granger CB, Zabel KM, Pieper KS; et al. (1998). "Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries". JAMA. 279 (5): 387–91. PMID 9459474.
  7. ↑ Hasdai D, Harrington RA, Hochman JS, Califf RM, Battler A, Box JW; et al. (2000). "Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST-segment elevation". J Am Coll Cardiol. 36 (3): 685–92. PMID 10987585.
  8. ↑ Sgarbossa EB, Pinski SL, Topol EJ, Califf RM, Barbagelata A, Goodman SG; et al. (1998). "Acute myocardial infarction and complete bundle branch block at hospital admission: clinical characteristics and outcome in the thrombolytic era. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA [tissue-type plasminogen activator] for Occluded Coronary Arteries". J Am Coll Cardiol. 31 (1): 105–10. PMID 9426026.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 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.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 Hasdai, David; Califf, Robert M.; Thompson, Trevor D.; Hochman, Judith S.; Ohman, E.Magnus; Pfisterer, Matthias; Bates, Eric R.; Vahanian, Alec; Armstrong, Paul W.; Criger, Douglas A.; Topol, Eric J.; Holmes, David R. (2000). "Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction". Journal of the American College of Cardiology. 35 (1): 136–143. doi:10.1016/S0735-1097(99)00508-2. ISSN 0735-1097.
  11. ↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
  12. ↑ Antman, EM.; Hand, M.; Armstrong, PW.; Bates, ER.; Green, LA.; Halasyamani, LK.; Hochman, JS.; Krumholz, HM.; Lamas, GA. (2008). "2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". J Am Coll Cardiol. 51 (2): 210–47. doi:10.1016/j.jacc.2007.10.001. PMID 18191746. Unknown parameter |month= ignored (help)
  13. ↑ 13.0 13.1 Hasdai D, Holmes DR, Califf RM, Thompson TD, Hochman JS, Pfisterer M; et al. (1999). "Cardiogenic shock complicating acute myocardial infarction: predictors of death. GUSTO Investigators. Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries". Am Heart J. 138 (1 Pt 1): 21–31. PMID 10385759.
  14. ↑ Jeger RV, Harkness SM, Ramanathan K, Buller CE, Pfisterer ME, Sleeper LA; et al. (2006). "Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry". Eur Heart J. 27 (6): 664–70. doi:10.1093/eurheartj/ehi729. PMID 16423873.
  15. ↑ Ortolani P, Marzocchi A, Marrozzini C, Palmerini T, Saia F, Serantoni C; et al. (2006). "Clinical impact of direct referral to primary percutaneous coronary intervention following pre-hospital diagnosis of ST-elevation myocardial infarction". Eur Heart J. 27 (13): 1550–7. doi:10.1093/eurheartj/ehl006. PMID 16707549.
  16. ↑ 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.
  17. ↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
  18. ↑ Brookes, C.; Ravn, H.; White, P.; Moeldrup, U.; Oldershaw, P.; Redington, A. (1999). "Acute Right Ventricular Dilatation in Response to Ischemia Significantly Impairs Left Ventricular Systolic Performance". Circulation. 100 (7): 761–767. doi:10.1161/01.CIR.100.7.761. ISSN 0009-7322.
  19. ↑ Tcheng JE, Jackman JD, Nelson CL, Gardner LH, Smith LR, Rankin JS; et al. (1992). "Outcome of patients sustaining acute ischemic mitral regurgitation during myocardial infarction". Ann Intern Med. 117 (1): 18–24. PMID 1596043.
  20. ↑ SANDERS RJ, KERN WH, BLOUNT SG (1956). "Perforation of the interventricular septum complicating myocardial infarction; a report of eight cases, one with cardiac catheterization". Am Heart J. 51 (5): 736–48. PMID 13302144.
  21. ↑ Skillington PD, Davies RH, Luff AJ, Williams JD, Dawkins KD, Conway N; et al. (1990). "Surgical treatment for infarct-related ventricular septal defects. Improved early results combined with analysis of late functional status". J Thorac Cardiovasc Surg. 99 (5): 798–808. PMID 2329817.
  22. ↑ Hutchins GM (1979). "Rupture of the interventricular septum complicating myocardial infarction: pathological analysis of 10 patients with clinically diagnosed perforations". Am Heart J. 97 (2): 165–73. PMID 760447.
  23. ↑ Daggett WM, Buckley MJ, Akins CW, Leinbach RC, Gold HK, Block PC; et al. (1982). "Improved results of surgical management of postinfarction ventricular septal rupture". Ann Surg. 196 (3): 269–77. PMC 1352596. PMID 7114934.
  24. ↑ 24.0 24.1 24.2 24.3 Mann JM, Roberts WC (1988). "Rupture of the left ventricular free wall during acute myocardial infarction: analysis of 138 necropsy patients and comparison with 50 necropsy patients with acute myocardial infarction without rupture". Am J Cardiol. 62 (13): 847–59. PMID 3052010.
  25. ↑ Bates RJ, Beutler S, Resnekov L, Anagnostopoulos CE (1977). "Cardiac rupture--challenge in diagnosis and management". Am J Cardiol. 40 (3): 429–37. PMID 331926.
  26. ↑ 26.0 26.1 26.2 Figueras J, Curos A, Cortadellas J, Sans M, Soler-Soler J (1995). "Relevance of electrocardiographic findings, heart failure, and infarct site in assessing risk and timing of left ventricular free wall rupture during acute myocardial infarction". Am J Cardiol. 76 (8): 543–7. PMID 7677073.
  27. ↑ Lewis AJ, Burchell HB, Titus JL (1969). "Clinical and pathologic features of postinfarction cardiac rupture". Am J Cardiol. 23 (1): 43–53. PMID 5380841.
  28. ↑ Dellborg M, Held P, Swedberg K, Vedin A (1985). "Rupture of the myocardium. Occurrence and risk factors". Br Heart J. 54 (1): 11–6. PMC 481840. PMID 4015910.
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