Cardiogenic shock natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
Cardiogenic shock is associated with cardiac, renal and pulmonary complications. In addition, cardiogenic shock is associated with a poor prognosis, particularly in the elderly. | Cardiogenic shock is associated with [[cardiac]], [[renal]] and [[pulmonary]] [[complications]]. In addition, cardiogenic shock is associated with a poor prognosis, particularly in the [[elderly]]. | ||
==Complications== | ==Complications== | ||
Complications of cardiogenic shock include: | [[Complications]] of cardiogenic shock include: | ||
===Cardiac=== | ===Cardiac=== | ||
A downward spiral of hypotension leading to reduced coronary perfusion leading to further hypotension and a further reduction in coronary perfusion | A downward spiral of [[hypotension]] leading to reduced [[coronary]] [[perfusion]] leading to further [[hypotension]] and a further reduction in [[coronary]] [[perfusion]] | ||
===Neurologic=== | ===Neurologic=== | ||
Coma | [[Coma]] | ||
===Renal=== | ===Renal=== | ||
[[Oliguria]] [[renal failure]] | |||
===Pulmonary=== | ===Pulmonary=== | ||
Cardiogenic [[pulmonary edema]] | Cardiogenic [[pulmonary edema]] | ||
==Prognosis== | ==Prognosis== | ||
*CS occurs in 8% of hospitalized STEMI patient with a mortality rate of 50-60% within 30 days.<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> | *CS occurs in 8% of hospitalized [[STEMI]] patient with a [[mortality rate]] of 50-60% within 30 days.<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> | ||
* 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]] | ||
*CS is associated with more severe lesions in coronary territories with 53% with three vessel diseases and 16 with only left main disease.<ref name="Wong-2000">{{Cite journal | last1 = Wong | first1 = SC. | last2 = Sanborn | first2 = T. | last3 = Sleeper | first3 = LA. | last4 = Webb |first4 = JG. | last5 = Pilchik | first5 = R. | last6 = Hart | first6 = D. | last7 = Mejnartowicz | first7 = S. | last8 = Antonelli | first8 = TA. |last9 = Lange | first9 = R. | title = Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? | journal = J Am Coll Cardiol | volume = 36 | issue = 3 Suppl A | pages = 1077-83 | month = Sep | year = 2000 | doi = | PMID = 10985708 }}</ref> | *CS is associated with more severe lesions in [[coronary]] territories with 53% with three vessel diseases and 16 with only left main disease.<ref name="Wong-2000">{{Cite journal | last1 = Wong | first1 = SC. | last2 = Sanborn | first2 = T. | last3 = Sleeper | first3 = LA. | last4 = Webb |first4 = JG. | last5 = Pilchik | first5 = R. | last6 = Hart | first6 = D. | last7 = Mejnartowicz | first7 = S. | last8 = Antonelli | first8 = TA. |last9 = Lange | first9 = R. | title = Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? | journal = J Am Coll Cardiol | volume = 36 | issue = 3 Suppl A | pages = 1077-83 | month = Sep | year = 2000 | doi = | PMID = 10985708 }}</ref> | ||
* 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> | * The [[mortality rate]] in cardiogenic shock is significantly higher when the culprit lesion is located in the [[left main coronary artery]] or [[saphenous vein]] graft, compared to that with lesions located 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> | * 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 [[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 | *The only way to prevent CS and to improve the outcomes is by early [[reperfusion]] therapy for [[MI]]. Early [[revascularization]] therapy, particularly by [[PCI]], shows global improvement in [[echocardiographic]] indicators, such as the [[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== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2] João André Alves Silva, M.D. [3]
Overview
Cardiogenic shock is associated with cardiac, renal and pulmonary complications. In addition, cardiogenic shock is associated with a poor prognosis, particularly in the elderly.
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
Renal
Pulmonary
Cardiogenic pulmonary edema
Prognosis
- CS occurs in 8% of hospitalized STEMI patient with a mortality rate of 50-60% within 30 days.[1]
- 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:[2]
- Older age
- Prior MI
- Signs of hypoperfusion including cold, clammy skin
- Altered mental state
- Oliguria
- CS is associated with more severe lesions in coronary territories with 53% with three vessel diseases and 16 with only left main disease.[3]
- The mortality rate in cardiogenic shock is significantly higher when the culprit lesion is located in the left main coronary artery or saphenous vein graft, compared to that with lesions located in the circumflex, left anterior descending, or right coronary artery.[4]
- There is no difference in the mortality rate in cardiogenic shock between STEMI and NSTEMI.[5]
- The left ventricular ejection fraction (LVEF) and the severity of mitral regurgitation (MR) are echocardiographic predictors for mortality in cardiogenic shock.[6]
- The only way to prevent CS and to improve the outcomes is by early reperfusion therapy for MI. Early revascularization therapy, particularly by PCI, shows global improvement in echocardiographic indicators, such as the LVEF and MR grade.[6]
References
- ↑ 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) - ↑ 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.
- ↑ Wong, SC.; Sanborn, T.; Sleeper, LA.; Webb, JG.; Pilchik, R.; Hart, D.; Mejnartowicz, S.; Antonelli, TA.; Lange, R. (2000). "Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?". J Am Coll Cardiol. 36 (3 Suppl A): 1077–83. PMID 10985708. Unknown parameter
|month=ignored (help) - ↑ 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) - ↑ 6.0 6.1 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)