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DOI: 10.1055/s-0031-1287869
Cardiovascular Failure and Cardiogenic Shock
Publication History
Publication Date:
11 October 2011 (online)
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ABSTRACT
Cardiovascular system failure is commonly faced by the intensivist. Heart failure can occur due to a host of predisposing cardiac disorders or as secondary effects of systemic illness. When the heart is unable to provide an adequate cardiac output to maintain adequate tissue perfusion, cardiogenic shock ensues. Without prompt diagnosis and appropriate management, these patients have significant morbidity and mortality, with in-hospital mortality approaching 60% for all age groups. Accurate and rapid identification of cardiogenic shock as a medical emergency, with expeditious implementation of appropriate therapy, can lead to improved clinical outcomes. In this review, we discuss optimal strategies for diagnosis and monitoring of cardiogenic shock. We discuss the diverse therapeutic strategies employed for cardiogenic shock, including pharmacological (e.g., vasoactive agents, fibrinolytic agents), mechanical (e.g., intraaortic balloon pumps, left ventricular assist devices, percutaneous coronary intervention [PCI]), and surgical approaches such as coronary artery bypass graft (CABG), valvular repair or replacement (e.g., for acute mitral regurgitation, ventricular septal rupture, or free wall rupture).
KEYWORDS
Cardiogenic shock - intensive care - myocardial infarction - echocardiography - right heart catheterization - vasopressor therapy - inotropic therapy
REFERENCES
- 1 Sarswat N, Hollenberg S M. Cardiogenic shock. Hosp Pract (Minneap). 2010; 38 (1) 74-83
- 2 Hochman J S, Boland J, Sleeper L A SHOCK Registry Investigators et al. Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Results of an international registry. Circulation. 1995; 91 (3) 873-881
- 3 Goldberg R J, Spencer F A, Gore J M, Lessard D, Yarzebski J. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009; 119 (9) 1211-1219
- 4 Hollenberg S M, Kavinsky C J, Parrillo J E. Cardiogenic shock. Ann Intern Med. 1999; 131 (1) 47-59
- 5 Hollenberg S M. Recognition and treatment of cardiogenic shock. Semin Respir Crit Care Med. 2004; 25 (6) 661-671
- 6 Hochman J S, Boland J, Sleeper L A SHOCK Registry Investigators et al. Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Results of an international registry. Circulation. 1995; 91 (3) 873-881
- 7 Holmes Jr D R, Bates E R, Kleiman N S et al.. Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol. 1995; 26 (3) 668-674
- 8 Hollenberg S M, Kavinsky C J, Parrillo J E. Cardiogenic shock. Ann Intern Med. 1999; 131 (1) 47-59
- 9 Hochman J S. Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation. 2003; 107 (24) 2998-3002
- 10 Picard M H, Davidoff R, Sleeper L A SHOCK Trial. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK et al. Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. Circulation. 2003; 107 (2) 279-284
- 11 Kohsaka S, Menon V, Lowe A M SHOCK Investigators et al. Systemic inflammatory response syndrome after acute myocardial infarction complicated by cardiogenic shock. Arch Intern Med. 2005; 165 (14) 1643-1650
- 12 Jeger R V, Assmann S F, Yehudai L, Ramanathan K, Farkouh M E, Hochman J S. Causes of death and re-hospitalization in cardiogenic shock. Acute Card Care. 2007; 9 (1) 25-33
- 13 Bolli R. Basic and clinical aspects of myocardial stunning. Prog Cardiovasc Dis. 1998; 40 (6) 477-516
- 14 Gerber B L, Wijns W, Vanoverschelde J L et al.. Myocardial perfusion and oxygen consumption in reperfused noninfarcted dysfunctional myocardium after unstable angina: direct evidence for myocardial stunning in humans. J Am Coll Cardiol. 1999; 34 (7) 1939-1946
- 15 Wijns W, Vatner S F, Camici P G. Hibernating myocardium. N Engl J Med. 1998; 339 (3) 173-181
- 16 Kloner R A, Jennings R B. Consequences of brief ischemia: stunning, preconditioning, and their clinical implications: part 1. Circulation. 2001; 104 (24) 2981-2989
- 17 Korewicki J. Cardiac transplantation is still the method of choice in the treatment of patients with severe heart failure. Cardiol J. 2009; 16 (6) 493-499
- 18 Rose E A, Gelijns A C, Moskowitz A J Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) Study Group et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001; 345 (20) 1435-1443
- 19 Selman L, Harding R, Beynon T et al.. Improving end-of-life care for patients with chronic heart failure: “let's hope it'll get better, when I know in my heart of hearts it won't”. Heart. 2007; 93 (8) 963-967
- 20 McCarthy III R E, Boehmer J P, Hruban R H et al.. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med. 2000; 342 (10) 690-695
- 21 Gupta S, Markham D W, Drazner M H, Mammen P P. Fulminant myocarditis. Nat Clin Pract Cardiovasc Med. 2008; 5 (11) 693-706
- 22 Klein R M, Vester E G, Brehm M U et al.. [Inflammation of the myocardium as an arrhythmia trigger]. Z Kardiol. 2000; 89 (Suppl 3) 24-35
- 23 Cooper Jr L T. Myocarditis. N Engl J Med. 2009; 360 (15) 1526-1538
- 24 Wittstein I S, Thiemann D R, Lima J A et al.. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005; 352 (6) 539-548
- 25 Movahed M R. Important echocardiographic features of takotsubo or stress-induced cardiomyopathy that can aid early diagnosis. JACC Cardiovasc Imaging. 2010; 3 (11) 1200-1201 author reply 1201
- 26 Huffman C, Wagman G, Fudim M, Zolty R, Vittorio T. Reversible cardiomyopathies—a review. Transplant Proc. 2010; 42 (9) 3673-3678
- 27 Filsoufi F, Salzberg S P, Adams D H. Current management of ischemic mitral regurgitation. Mt Sinai J Med. 2005; 72 (2) 105-115
- 28 Filsoufi F, Rahmanian P B, Anyanwu A, Adams D H. Physiologic basis for the surgical treatment of ischemic mitral regurgitation. Am Heart Hosp J. 2006; 4 (4) 261-268
- 29 Choudhry N K, Etchells E E. The rational clinical examination. Does this patient have aortic regurgitation?. JAMA. 1999; 281 (23) 2231-2238
- 30 Morganroth J, Perloff J K, Zeldis S M, Dunkman W B. Acute severe aortic regurgitation: pathophysiology, clinical recognition, and management. Ann Intern Med. 1977; 87 (2) 223-232
- 31 Nohria A, Tsang S W, Fang J C et al.. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol. 2003; 41 (10) 1797-1804
- 32 de Denus S, Pharand C, Williamson D R. Brain natriuretic peptide in the management of heart failure: the versatile neurohormone. Chest. 2004; 125 (2) 652-668
- 33 Maisel A S, Krishnaswamy P, Nowak R M Breathing Not Properly Multinational Study Investigators et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002; 347 (3) 161-167
- 34 Logeart D, Saudubray C, Beyne P et al.. Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea. J Am Coll Cardiol. 2002; 40 (10) 1794-1800
- 35 Antman E M, Hand M, Armstrong P W Canadian Cardiovascular Society et al. 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. 2008; 51 (2) 210-247
- 36 Hochman J S, Sleeper L A, Webb J G et al.. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999; 341 (9) 625-634
- 37 Menon V, Slater J N, White H D, Sleeper L A, Cocke T, Hochman J S. Acute myocardial infarction complicated by systemic hypoperfusion without hypotension: report of the SHOCK trial registry. Am J Med. 2000; 108 (5) 374-380
- 38 Forrester J S, Diamond G, Chatterjee K, Swan H JC. Medical therapy of acute myocardial infarction by application of hemodynamic subsets (second of two parts). N Engl J Med. 1976; 295 (25) 1404-1413
- 39 De Backer D, Biston P, Devriendt J SOAP II Investigators et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010; 362 (9) 779-789
- 40 Antman E M, Anbe D T, Armstrong P W 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) et al. 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. 2004; 110 (5) 588-636
- 41 Felker G M, Benza R L, Chandler A B OPTIME-CHF Investigators et al. Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study. J Am Coll Cardiol. 2003; 41 (6) 997-1003
- 42 Elahi M M, Lam J, Asopa S, Matata B M. Levosimendan Versus an Intra-aortic Balloon Pump in Adult Cardiac Surgery Patients With Low Cardiac Output. J Cardiothorac Vasc Anesth. 2011 Mar 2. [Epub ahead of print] No abstract available
- 43 Russ M A, Prondzinsky R, Christoph A et al.. Hemodynamic improvement following levosimendan treatment in patients with acute myocardial infarction and cardiogenic shock. Crit Care Med. 2007; 35 (12) 2732-2739
- 44 García-González M J, Domínguez-Rodríguez A, Ferrer-Hita J J, Abreu-González P, Muñoz M B. Cardiogenic shock after primary percutaneous coronary intervention: effects of levosimendan compared with dobutamine on haemodynamics. Eur J Heart Fail. 2006; 8 (7) 723-728
- 45 Mebazaa A, Nieminen M S, Packer M SURVIVE Investigators et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA. 2007; 297 (17) 1883-1891
- 46 Bates E R, Stomel R J, Hochman J S, Ohman E M. The use of intraaortic balloon counterpulsation as an adjunct to reperfusion therapy in cardiogenic shock. Int J Cardiol. 1998; 65 (Suppl 1) S37-S42
- 47 Barron H V, Every N R, Parsons L S Investigators in the National Registry of Myocardial Infarction 2 et al. The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2. Am Heart J. 2001; 141 (6) 933-939
- 48 Sanborn T A, Sleeper L A, Bates E R et al.. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in 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. 2000; 36 (3, Suppl A) 1123-1129
- 49 Thiele H, Sick P, Boudriot E et al.. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005; 26 (13) 1276-1283
- 50 Burkhoff D, Cohen H, Brunckhorst C, O'Neill W W. TandemHeart Investigators Group . A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J. 2006; 152 (3) 469 e1-e8
- 51 Seyfarth M, Sibbing D, Bauer I et al.. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008; 52 (19) 1584-1588
- 52 Cheng J M, den Uil C A, Hoeks S E et al.. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009; 30 (17) 2102-2108
- 53 Becker R C. Hemodynamic, mechanical, and metabolic determinants of thrombolytic efficacy: a theoretic framework for assessing the limitations of thrombolysis in patients with cardiogenic shock. Am Heart J. 1993; 125 (3) 919-929
- 54 Hochman J S, Sleeper L A, White H D SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock et al. One-year survival following early revascularization for cardiogenic shock. JAMA. 2001; 285 (2) 190-192
- 55 Dzavik V, Sleeper L A, Picard M H SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK Investigators et al. Outcome of patients aged > or = 75 years in the SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) trial: do elderly patients with acute myocardial infarction complicated by cardiogenic shock respond differently to emergent revascularization?. Am Heart J. 2005; 149 (6) 1128-1134
- 56 White H D, Assmann S F, Sanborn T A et al.. Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock: results from the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial. Circulation. 2005; 112 (13) 1992-2001
- 57 Thompson C R, Buller C E, Sleeper L A et al.. Cardiogenic shock due to acute severe mitral regurgitation complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we use emergently revascularize Occluded Coronaries in cardiogenic shocK?. J Am Coll Cardiol. 2000; 36 (3, Suppl A) 1104-1109
- 58 Antman E M, Anbe D T, Armstrong P W 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) et al. 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. 2004; 110 (5) 588-636
Steven M HollenbergM.D.
Cardiology and Critical Care Medicine, Cooper University Hospital, One Cooper Plaza
366 Dorrance, Camden, NJ 08103
Email: Hollenberg-Steven@cooperhealth.edu