scholarly journals Evidence-based Management of Cardiogenic Shock After Acute Myocardial Infarction

2013 ◽  
Vol 8 (2) ◽  
pp. 73 ◽  
Author(s):  
Karl Werdan ◽  
Martin Russ ◽  
Michael Buerke ◽  
Roland Prondzinsky ◽  
Sebastian Dietz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Multiple Organ ◽  
Class I ◽  
Evidence Based ◽  
Level Of Evidence ◽  
Expert Opinions ◽  
Cardiovascular Therapy ◽  
High Level

Guidelines for evidence-based management of patients with cardiogenic shock after acute myocardial infarction focuses on early revascularisation of the occluded coronary artery as well as on support of cardiac failure and improvement of impaired organ perfusion. Also of great importance is effective treatment of shock complications, especially acute respiratory failure and other forms of multiple organ dysfunction syndrome (MODS). Cardiovascular therapy has to be accompanied by best general intensive care of these critically ill patients with high mortality. Most lives can be saved by early revascularisation, and this class I recommendation has a high level of evidence. So far, most of the other guideline recommendations are of low evidence level, in most cases based on expert opinions. Recently, the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP SHOCK II) trial with 600 patients has shown that adjunctive IABP therapy – for long a class I recommendation – does not reduce 30-day and six-month motality.

Treatment of Acute Myocardial Infarction with Cardiogenic Shock using Left Ventricular Assist Device

1989 ◽  
Vol 12 (3) ◽  
pp. 175-179 ◽  
Author(s):  
H. Noda ◽  
H. Takano ◽  
Y. Taenaka ◽  
T. Nakatani ◽  
M. Umezu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Multiple Organ ◽  
Left Ventricular ◽  
Bypass Grafting ◽  
Assist Device ◽  
Ventricular Assist ◽  
The Third ◽  
Left Ventricular Assist

We have treated ten cardiogenic shock patients after acute myocardial infarction (AMI) with a left ventricular assist device (LVAD). These patients were later divided into three groups: the first group with ventricular septal perforation, the second with aorto-coronary bypass grafting (ACBG) before LVAD implantation and the third group without ACBG. LVAD maintained the systemic circulation in each group, and cardiac function recovered enough to remove LVAD in 70% of the total patients. Two of three patients in the first group were discharged from hospital. Two weaned cases in the second group died of multiple organ failure and one was discharged, and hemorrhagic necrosis was seen in the bypassed area of the myocardium. One patient of the third group could not be weaned from LVAD because of respiratory failure though his heart function began to recover. Another case in the third group underwent bypass grafting after removal of LVAD. However ACBG surgery should be done very carefully because a patient in shock is occasionally intolerant to major surgery. In all groups, the major cause of death was multiple organ failure which was probably caused by the prolonged low output condition prior to LVAD application. In the light of this experience, it appears that LVAD should be applied before irreversible damage occurs to major organs, including the heart itself. To ensure the timely application of LVAD, some way must be found to introduce systematic application of LVAD into the normal course of AMI treatment.

scholarly journals Multiple organ dysfunction caused by acute myocardial infarction without typical symptom of cardiogenic shock

2014 ◽  
Vol 25 (4) ◽  
pp. 171-178
Author(s):  
Hiroshi Imamura ◽  
Masataka Ozawa ◽  
Ken-ichi Nitta ◽  
Tomomi Iwashita ◽  
Toshio Sato ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Organ Dysfunction ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Typical Symptom

scholarly journals The German–Austrian S3 Guideline “Cardiogenic Shock Due to Myocardial Infarction: Diagnosis, Monitoring, and Treatment”

2020 ◽  
Author(s):  
Kevin Pilarczyk ◽  
Karl Werdan ◽  
Martin Russ ◽  
Holger Thiele ◽  
Guido Michels ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Contractile Function ◽  
German Society ◽  
Evidence Based ◽  
Cardiac Contractile Function ◽  
Intensive Care Unit Treatment ◽  
S3 Guideline ◽  
Cardiac Contractile

AbstractDespite advances in the treatment of acute myocardial infarction with subsequent mortality reduction, which are mainly caused by the early timing of revascularization, cardiogenic shock still remains the leading cause of death with mortality rates still approaching 40 to 50%. Cardiogenic shock is characterized by a multiorgan dysfunction syndrome, often complicated by a systemic inflammatory response syndrome that affects the outcome more than the reduction of the cardiac contractile function. However, both European and American guidelines on myocardial infarction focus on interventional or surgical aspects only. Therefore, experts from eight German and Austrian specialty societies including the German Society for Thoracic and Cardiovascular Surgery published the German–Austrian S3 guideline “cardiogenic shock due to myocardial infarction: diagnosis, monitoring, and treatment” to provide evidence-based recommendations for the diagnosis and treatment of infarction-related cardiogenic shock in 2010 covering the topics of early revascularization, revascularization techniques, intensive care unit treatment including ventilation, transfusion regimens, adjunctive medical therapy, and mechanical support devices. Within the last 3 years, this guideline was updated as some major recommendations were outdated, or new evidence had been found. This review will therefore outline the management of patients with cardiogenic shock complicating acute myocardial infarction according to the updated guideline with a major focus on evidence-based recommendations which have been found relevant for cardiac surgery.

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