Cardiogenic shock: causes, diagnosis and treatment

master's thesis

• Title (croatian): Kardiogeni šok
• Author: Marko Ilari Kavilo
• Mentor: Matias Trbušić (mentor)
• Committee member: Matias Trbušić (predsjednik povjerenstva)
• Committee member: Nikola Bulj (član povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

The most common cause for CS is LV failure in the setting of STEMI. The infarct is located most likely in the anterior wall. Currently CS is complicating between 8 to 9% of patients with STEMI and 2,5% of patients with NSTEMI. Mortality is high with 50%. CS has a complex pathophysiology. It results from permanent or temporary disruptions in the whole circulatory system. In addition to mechanical disruptions, neurohormones, inflammation and peripheral vasculature also play a major role in the pathophysiology of CS. Diagnosis of CS can be usually made by easy-to-access criteria. Detailed physical examination, electrocardiogram, laboratory studies and echocardiography play all a major role in assessing the patients. PA catheters may be used for diagnosis and advanced hemodynamic monitoring, but it is not obligatory. Treatment of CS involves several different aspects from which the first one is intensive care treatment with fluids, vasopressors and inotropes. The goals of the treatment of CS are optimizing MAP and CO while keeping the risk of pulmonary edema low. Therapeutic hypothermia has also proven its benefit in treating CS patients after resuscitation. Prevention and treatments of multiorgan system dysfunction should be also emphasized since it greatly affects the patients prognosis. Modern medicine has also made available several different mechanical circulatory support devices that can work either as a bridge to therapeutic resolution, as a bridge to transplant or as a bridge to long-term mechanical circulatory support device. The IABP didn’t prove its usefulness in patients with CS. On the other side, despite the expectations and optimistic first results, the use of pVADs didn’t decrease the short or long-term mortality when compared to IABP in patients with CS.

Abstract (croatian)

Najčešći uzrok kardiogenog šoka (engl. cardiogenic shock – CS) je akutno zatajivanje srca u kontekstu akutnog infarkta miokarda, osobito prednje stijenke. U današnje vrijeme CS prisutan je u 8-9% bolesnika s infarktom miokarda sa ST elevacijom (STEMI) i u 2,5% bolesnika s infarktom miokarda bez ST elevacije. Smrtnost je visoka i iznosi oko 50%. Patofiziologija CS je kompleksna. Dolazi do privremenih ili trajnih poremećaja u cijelom cirkulacijskom sustavu. Osim mehaničkih poremećaja, neurohormoni, upala i periferna vaskulatura također igraju važnu ulogu u patofiziologiji CS. Dijagnoza CS može se postaviti na temelju jednostavnih kriterija. Detaljni fizikalni pregled, elektrokardiogram, laboratorijske pretrage i ehokardiografija su ključni u inicijalnoj procjeni bolesnika. Kateterizacija plućne arterije može se koristiti za dijagnozu i napredno hemodinamičko praćenje, ali nije nužna. Liječenje CS uključuje nekoliko različitih aspekata, ali osnova je intenzivna skrb uz primjenu volumena, vasopresora i inotropa. Ciljevi liječenja CS su optimiziranje tlaka u plućnoj arteriji i minutnog volumena, održavajući rizik od plućnog edema na najnižoj mogućoj razini. Terapeutska hipotermija također je dokazala svoju korist kod liječenja bolesnika sa CS nakon oživljavanja. Važna je i prevencija i liječenje multiorganskog zatajivanja koje uvelike utječe na prognozu bolesnika. U modernom liječenju danas je dostupno nekoliko različitih mehaničkih cirkulacijskih uređaja za podršku koji mogu služiti kao premoštenje do oporavka, transplantacije ili kao premoštenje do ugradnje dugoročnog mehaničkog cirkulacijskog uređaja za podršku. Nije dokazana korist od primjene intra-aortne balon pumpe (IABP) kod bolesnika u CS. S druge strane, unatoč očekivanjima i optimističnim prvim rezultatima, uporaba pVADs nije smanjila kratkotrajnu ili dugoročnu smrtnost u usporedbi s IABP-om u bolesnika s CS.

• Keywords: cardiogenic shock; myocardial Infarction; acute coronary syndrome
• Keywords (croatian): kardiogeni šok; infarkt miokarda; akutni koronarni sindrom
• Language: english
• URN:NBN: urn:nbn:hr:105:961626
• Study programme: Title: Medicine (in English language); Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-07-15 10:48:21