Cardiogenic shock natural history, complications and prognosis: Difference between revisions
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==Prognosis== | ==Prognosis== | ||
Cardiogenic shock carries a very poor prognosis, particularly in the elderly. In the GUSTO 1 trial, the following were identified as correlates of higher mortality among patients with cardiogenic shock:<ref>Hasdai D, Califf RM, Thompson TD, et al. Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction. J Am Coll Cardiol. Jan 2000;35(1):136-43.</ref> | * Cardiogenic shock carries a very poor prognosis, particularly in the elderly. In the GUSTO 1 trial, the following were identified as correlates of higher mortality among patients with cardiogenic shock:<ref>Hasdai D, Califf RM, Thompson TD, et al. Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction. J Am Coll Cardiol. Jan 2000;35(1):136-43.</ref> | ||
*Older age | **Older age | ||
*Prior MI | **Prior MI | ||
*Signs of hypoperfusion including cold, clammy skin | **Signs of hypoperfusion including cold, clammy skin | ||
*[[Altered mental state]] | **[[Altered mental state]] | ||
*[[Oliguria]] | **[[Oliguria]] | ||
* The mortality rate in cardiogenic shock is significantly higher when the culprit lesion is in the left main artery or [[saphenous vein]] graft compared to that with lesions in the [[circumflex]], [[left anterior descending]], or [[right coronary artery]].<ref name="Sanborn-2003">{{Cite journal | last1 = Sanborn | first1 = TA. | last2 = Sleeper | first2 = LA. | last3 = Webb | first3 = JG. | last4 = French | first4 = JK. | last5 = Bergman | first5 = G. | last6 = Parikh | first6 = M. | last7 = Wong | first7 = SC. | last8 = Boland | first8 = J. | last9 = Pfisterer | first9 = M. | title = Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial. | journal = J Am Coll Cardiol | volume = 42 | issue = 8 | pages = 1373-9 | month = Oct | year = 2003 | doi = | PMID = 14563577 }}</ref> | |||
* There is no difference in the mortality rate in cardiogenic shock between STEMI and NSTEMI.<ref name="Holmes-1999">{{Cite journal | last1 = Holmes | first1 = DR. | last2 = Berger | first2 = PB. | last3 = Hochman | first3 = JS. | last4 = Granger | first4 = CB. | last5 = Thompson | first5 = TD. | last6 = Califf | first6 = RM. | last7 = Vahanian | first7 = A. | last8 = Bates | first8 = ER. | last9 = Topol | first9 = EJ. | title = Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation. | journal = Circulation | volume = 100 | issue = 20 | pages = 2067-73 | month = Nov | year = 1999 | doi = | PMID = 10562262 }}</ref> | |||
* The left ventricular ejection fraction (LVEF) and the severity of mitral regurgitation (MR) are echocardiographic predictors for mortality in cardiogenic shock.<ref name="Picard-2003">{{Cite journal | last1 = Picard | first1 = MH. | last2 = Davidoff | first2 = R. | last3 = Sleeper | first3 = LA. | last4 = Mendes | first4 = LA. | last5 = Thompson | first5 = CR. | last6 = Dzavik | first6 = V. | last7 = Steingart | first7 = R. | last8 = Gin | first8 = K. | last9 = White | first9 = HD. | title = Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. | journal = Circulation | volume = 107 | issue = 2 | pages = 279-84 | month = Jan | year = 2003 | doi = | PMID = 12538428 }}</ref> | |||
*The only way to prevent CS or to improve the outcomes is the early reperfusion therapy for MI. As the early revascularization therapy particularly by PCI shows global improvement in echocardgiographic indicators as LVEF and MR grade.<ref name="Picard-2003">{{Cite journal | last1 = Picard | first1 = MH. | last2 = Davidoff | first2 = R. | last3 = Sleeper | first3 = LA. | last4 = Mendes | first4 = LA. | last5 = Thompson | first5 = CR. | last6 = Dzavik | first6 = V. | last7 = Steingart | first7 = R. | last8 = Gin | first8 = K. | last9 = White | first9 = HD. | title = Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. | journal = Circulation | volume = 107 | issue = 2 | pages = 279-84 | month = Jan | year = 2003 | doi = | PMID = 12538428 }}</ref> | |||
==References== | ==References== | ||
Revision as of 01:28, 27 December 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Complications
Complications of cardiogenic shock include:
Cardiac
A downward spiral of hypotension leading to reduced coronary perfusion leading to further hypotension and a further reduction in coronary perfusion
Neurologic
Coma
Renal
Oligurin renal failure
Pulmonary
Cardiogenic pulmonary edema
Prognosis
- Cardiogenic shock carries a very poor prognosis, particularly in the elderly. In the GUSTO 1 trial, the following were identified as correlates of higher mortality among patients with cardiogenic shock:[1]
- Older age
- Prior MI
- Signs of hypoperfusion including cold, clammy skin
- Altered mental state
- Oliguria
- The mortality rate in cardiogenic shock is significantly higher when the culprit lesion is in the left main artery or saphenous vein graft compared to that with lesions in the circumflex, left anterior descending, or right coronary artery.[2]
- There is no difference in the mortality rate in cardiogenic shock between STEMI and NSTEMI.[3]
- The left ventricular ejection fraction (LVEF) and the severity of mitral regurgitation (MR) are echocardiographic predictors for mortality in cardiogenic shock.[4]
- The only way to prevent CS or to improve the outcomes is the early reperfusion therapy for MI. As the early revascularization therapy particularly by PCI shows global improvement in echocardgiographic indicators as LVEF and MR grade.[4]
References
- ↑ Hasdai D, Califf RM, Thompson TD, et al. Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction. J Am Coll Cardiol. Jan 2000;35(1):136-43.
- ↑ Sanborn, TA.; Sleeper, LA.; Webb, JG.; French, JK.; Bergman, G.; Parikh, M.; Wong, SC.; Boland, J.; Pfisterer, M. (2003). "Correlates of one-year survival inpatients with cardiogenic shock complicating acute myocardial infarction: angiographic findings from the SHOCK trial". J Am Coll Cardiol. 42 (8): 1373–9. PMID 14563577. Unknown parameter
|month=ignored (help) - ↑ Holmes, DR.; Berger, PB.; Hochman, JS.; Granger, CB.; Thompson, TD.; Califf, RM.; Vahanian, A.; Bates, ER.; Topol, EJ. (1999). "Cardiogenic shock in patients with acute ischemic syndromes with and without ST-segment elevation". Circulation. 100 (20): 2067–73. PMID 10562262. Unknown parameter
|month=ignored (help) - ↑ 4.0 4.1 Picard, MH.; Davidoff, R.; Sleeper, LA.; Mendes, LA.; Thompson, CR.; Dzavik, V.; Steingart, R.; Gin, K.; White, HD. (2003). "Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock". Circulation. 107 (2): 279–84. PMID 12538428. Unknown parameter
|month=ignored (help)