Cardiogenic shock other diagnostic studies: Difference between revisions
Joao Silva (talk | contribs) |
Joao Silva (talk | contribs) |
||
| Line 25: | Line 25: | ||
:*confirmation of [[diagnosis]] | :*confirmation of [[diagnosis]] | ||
:*calculation of [[shunt]] fraction | :*calculation of [[shunt]] fraction | ||
:*rise of | :*rise of ≥8% of [[oxygen saturation]] between [[RA]] and [[PA]] | ||
:* | :*location and size of [[VSR]], given by [[Left ventriculogram quality grades|left ventriculogram]], carried out during [[cardiac catheterization]] | ||
*In cardiogenic shock complicating '''[[free wall rupture]] and [[tamponade]]''', [[PA catheter]] may be useful in: | *In cardiogenic shock complicating '''[[free wall rupture]] and [[tamponade]]''', [[PA catheter]] may be useful in: | ||
Revision as of 04:34, 28 May 2014
|
Cardiogenic Shock Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Cardiogenic shock other diagnostic studies On the Web |
|
American Roentgen Ray Society Images of Cardiogenic shock other diagnostic studies |
|
Risk calculators and risk factors for Cardiogenic shock other diagnostic studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Attending to the catastrophic outcome of cardiogenic shock in a very short time span, its diagnosis must be reached as early as possible in order for proper therapy to be started. This period until diagnosis and treatment initiation is particularly important in the case of cardiogenic shock since the mortality rate of this condition complicating acute-MI is very high, along with the fact that the ability to revert the damage caused, through reperfusion techniques, declines considerably with diagnostic delays. Therefore and due to the unstable state of these patients, the diagnostic evaluations are usually performed as supportive measures are initiated. The diagnostic measures should start with the proper history and physical examination, including blood pressure measurement, followed by an EKG, echocardiography, chest x-ray and collection of blood samples for evaluation. The physician should keep in mind the common features of shock, irrespective of the type of shock, in order to avoid delays in the diagnosis. Although not all shock patients present in the same way, these features include: abnormal mental status, cool extremities, clammy skin, manifestations of hypoperfusion, such as hypotension and oliguria, as well as evidence of metabolic acidosis on the blood results.[1]
Other Diagnostic Studies
Swan Ganz Catheter
The Swan-ganz 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.[2] 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.[3] 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:[4][5][6][7]
- In cardiogenic shock complicating acute MR, PA catheter may reveal:[4][8]
- 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 show:[4][9]
- 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 be useful in:
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. [2][10]
Biopsy
In case of suspected cardiomyopathy a biopsy of heart muscle may be of benefit in establishing a definitive diagnosis.
References
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ 2.0 2.1 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.
- ↑ 4.0 4.1 4.2 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.