Cardiogenic shock secondary prevention: Difference between revisions

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


==Overview==
==Overview==
Cardiogenic shock is considered an [[emergency]] and irrespectively to the [[therapeutic]] approach, the target goal of any [[therapy]] is prompt [[revascularization]] of [[ischemic myocardium]]. This should be achieved in the shortest timespan possible. There are two major categories of treatment for cardiogenic shock, the ''medical/conservative approach'' and the ''interventional approach''. The ideal [[therapy|treatment]] combines both mechanisms, in which medical therapy, after restored filling pressures, allows [[hemodynamic|hemodynamical]] stabilization of the patient, until interventional methods, that contribute to the reversal of the process leading to the [[shock]] state, may performed. The interventional approach may include [[PCI]] or [[coronary artery bypass graft surgery]] ([[CABG]]) and in both techniques the goal is not only reperfusion of the occluded [[coronary artery]], but also prevention of [[coronary artery|vessel]] reoclusion. If there is no access to a [[cardiac catheterization]] facility, nor the possibility of transferring the patient to one within 90 minutes, then immediately [[thrombolytic therapy]] should be considered.<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> Other important factors to increase the chances of a better [[outcome]] are: [[mechanical ventilation]], in order to improve [[tissue]] [[oxygenation]], and close monitoring of the [[therapeutic]] dosages, particularly of [[vasoactive]] drugs, since these have been associated with excess [[mortality]] due to [[toxicity]] effects.<ref name="pmid17387132">{{cite journal| author=TRIUMPH Investigators. Alexander JH, Reynolds HR, Stebbins AL, Dzavik V, Harrington RA et al.| title=Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. | journal=JAMA | year= 2007 | volume= 297 | issue= 15 | pages= 1657-66 | pmid=17387132 | doi=10.1001/jama.297.15.joc70035 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17387132  }} </ref><ref name="pmid16505643">{{cite journal| author=Sakr Y, Reinhart K, Vincent JL, Sprung CL, Moreno R, Ranieri VM et al.| title=Does dopamine administration in shock influence outcome? Results of the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. | journal=Crit Care Med | year= 2006 | volume= 34 | issue= 3 | pages= 589-97 | pmid=16505643 | doi=10.1097/01.CCM.0000201896.45809.E3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16505643  }} </ref> Also, it is recommended [[invasive]] [[hemodynamic]] monitoring, in order to monitor and guide the effects of the [[therapy]] as well as the overall status of the patient. The success of [[reperfusion]] is usually suggested by the relief of [[symptoms]], restoration of [[hemodynamic]] parameters and electrical stability, as well as the reduction of at least 50% in the [[ST-segment]] on the [[EKG]], in the case of a [[STEMI]].<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><ref>{{cite book | last = Hochman | first = Judith | title = Cardiogenic shock | publisher = Wiley-Blackwell | location = Chichester, West Sussex, UK Hoboken, NJ | year = 2009 | isbn = 9781405179263 }}</ref>
[[Secondary prevention]] includes early detection and halting the progression of established but asymptomatic disease. For [[CAD]], this includes taking measures to prevent [[cardiovascular]] symptoms (e.g., [[dyspnea]]), damage (e.g., [[ventricular dysfunction]]), and events (e.g., [[acute coronary syndromes]]). However, once such symptoms, [[damage]], or events occur, it is too late for [[secondary prevention]].


==Secondary prevention==
==Secondary prevention==
Attending to the definition of [[secondary prevention]], namely the methods or techniques used in order to avoid the development of [[symptoms]] of an already existent [[disease]], and considering the fact that [[left ventricular failure]], following [[MI]] is the most common cause of cardiogenic shock, these patients should undergo [[secondary prevention]] of [[STEMI]]. This is a crucial part of the management of [[STEMI]] patients, regardless of their [[gender]].<ref name="pmid15289388">{{cite journal| author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M et al.| title=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). | journal=Circulation | year= 2004 | volume= 110 | issue= 5 | pages= 588-636 | pmid=15289388 | doi=10.1161/01.CIR.0000134791.68010.FA | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15289388  }} </ref>
Attending to the definition of [[secondary prevention]], namely the methods or techniques used in order to avoid the development of [[symptoms]] of an already existent [[disease]], and considering the fact that [[left ventricular failure]] following [[MI]] is the most common cause of cardiogenic shock, these patients should undergo [[secondary prevention]] of [[myocardial infarction]]. This is a crucial part of the management of [[STEMI]] patients, regardless of their [[gender]].<ref name="pmid15289388">{{cite journal| author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M et al.| title=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). | journal=Circulation | year= 2004 | volume= 110 | issue= 5 | pages= 588-636 | pmid=15289388 | doi=10.1161/01.CIR.0000134791.68010.FA | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15289388  }} </ref><ref name="SmithBlair2001">{{cite journal|last1=Smith|first1=S. C.|last2=Blair|first2=S. N.|last3=Bonow|first3=R. O.|last4=Brass|first4=L. M.|last5=Cerqueira|first5=M. D.|last6=Dracup|first6=K.|last7=Fuster|first7=V.|last8=Gotto|first8=A.|last9=Grundy|first9=S. M.|last10=Miller|first10=N. H.|last11=Jacobs|first11=A.|last12=Jones|first12=D.|last13=Krauss|first13=R. M.|last14=Mosca|first14=L.|last15=Ockene|first15=I.|last16=Pasternak|first16=R. C.|last17=Pearson|first17=T.|last18=Pfeffer|first18=M. A.|last19=Starke|first19=R. D.|last20=Taubert|first20=K. A.|title=AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients With Atherosclerotic Cardiovascular Disease: 2001 Update: A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology|journal=Circulation|volume=104|issue=13|year=2001|pages=1577–1579|issn=0009-7322|doi=10.1161/hc3801.097475}}</ref><ref name="Mosca2004">{{cite journal|last1=Mosca|first1=L.|title=Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women|journal=Circulation|volume=109|issue=5|year=2004|pages=672–693|issn=0009-7322|doi=10.1161/01.CIR.0000114834.85476.81}}</ref><ref name="pmid15031243">{{cite journal| author=Dalal H, Evans PH, Campbell JL| title=Recent developments in secondary prevention and cardiac rehabilitation after acute myocardial infarction. | journal=BMJ | year= 2004 | volume= 328 | issue= 7441 | pages= 693-7 | pmid=15031243 | doi=10.1136/bmj.328.7441.693 | pmc=PMC381231 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15031243  }} </ref> Since [[atherosclerotic]] disease is commonly found in multiple [[vessels]] in [[STEMI]] patients, these should be evaluated for possible [[signs]] or [[symptoms]] of [[peripheral vascular disease|peripheral vascular]] or [[cerebrovascular disease]].<ref name="pmid15289388">{{cite journal| author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M et al.| title=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). | journal=Circulation | year= 2004 | volume= 110 | issue= 5 | pages= 588-636 | pmid=15289388 | doi=10.1161/01.CIR.0000134791.68010.FA | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15289388  }} </ref> As [[secondary prevention]], these patients have the following indications:<ref name="pmid15289388">{{cite journal| author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M et al.| title=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). | journal=Circulation | year= 2004 | volume= 110 | issue= 5 | pages= 588-636 | pmid=15289388 | doi=10.1161/01.CIR.0000134791.68010.FA | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15289388  }} </ref>
*Education of patient and family members before discharge - particularly about the importance of lifestyle changes and adherence to the selected treatment.
*[[Physical exercise|Exercise/physical activity]] - with an optimal target of daily [[physical activity]] and a minimum of 30 minutes/day, 3 to 4 times per week.
*[[Lipid]] management - if [[TG]] <200 mg/dL, then goal of [[LDL-C]] <<100 mg/dL; if [[TG]] ≥200 mg/dL, then goal of [[non-HDL-C]] << 130 mg/dL
*[[Weight]] management - goal BMI of 18.5-24.9 kg/m<sup>2</sup> and Waist Perimeter: women - <35 inches, men - <40 inches.
*[[Blood pressure]] control - goal <140/90 mm Hg or <130/80 mm Hg if concomitant diabetes or kidney disease.
*Control of [[diabetes]] - goal of HbA1<sub>c</sub> < 7%.
*[[Smoking cessation]] - goal of complete cessation.
*[[Antiplatelet]] therapy
*[[RAAS]] inhibition
*[[beta blocker|Beta-blockage]]
*[[Hormone therapy]] in women
*[[Warfarin]] therapy
*[[Antioxidant]] intake


==References==
==References==

Latest revision as of 18:41, 8 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

Secondary prevention includes early detection and halting the progression of established but asymptomatic disease. For CAD, this includes taking measures to prevent cardiovascular symptoms (e.g., dyspnea), damage (e.g., ventricular dysfunction), and events (e.g., acute coronary syndromes). However, once such symptoms, damage, or events occur, it is too late for secondary prevention.

Secondary prevention

Attending to the definition of secondary prevention, namely the methods or techniques used in order to avoid the development of symptoms of an already existent disease, and considering the fact that left ventricular failure following MI is the most common cause of cardiogenic shock, these patients should undergo secondary prevention of myocardial infarction. This is a crucial part of the management of STEMI patients, regardless of their gender.[1][2][3][4] Since atherosclerotic disease is commonly found in multiple vessels in STEMI patients, these should be evaluated for possible signs or symptoms of peripheral vascular or cerebrovascular disease.[1] As secondary prevention, these patients have the following indications:[1]

References

  1. ↑ 1.0 1.1 1.2 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.
  2. ↑ Smith, S. C.; Blair, S. N.; Bonow, R. O.; Brass, L. M.; Cerqueira, M. D.; Dracup, K.; Fuster, V.; Gotto, A.; Grundy, S. M.; Miller, N. H.; Jacobs, A.; Jones, D.; Krauss, R. M.; Mosca, L.; Ockene, I.; Pasternak, R. C.; Pearson, T.; Pfeffer, M. A.; Starke, R. D.; Taubert, K. A. (2001). "AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients With Atherosclerotic Cardiovascular Disease: 2001 Update: A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology". Circulation. 104 (13): 1577–1579. doi:10.1161/hc3801.097475. ISSN 0009-7322.
  3. ↑ Mosca, L. (2004). "Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women". Circulation. 109 (5): 672–693. doi:10.1161/01.CIR.0000114834.85476.81. ISSN 0009-7322.
  4. ↑ Dalal H, Evans PH, Campbell JL (2004). "Recent developments in secondary prevention and cardiac rehabilitation after acute myocardial infarction". BMJ. 328 (7441): 693–7. doi:10.1136/bmj.328.7441.693. PMC 381231. PMID 15031243.


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