Cardiogenic shock: treatment

The treatment of cardiogenic shock complicating the acute coronary syndromes consists of medical therapy, percutaneous revascularization procedures, cardiac surgery, and the implantation of devices. Medical therapy is limited to different positive inotropic and vasoactive drugs, without any firm evidence of survival benefit using these drugs. Several new pharmacologic compounds are at different stages of clinical research, but are not yet routinely approved for the treatment of cardiogenic shock. The only evidence-based therapy with proven survival benefit is timely revascularization. Intra-aortic balloon pump counterpulsation maintains its central role as supportive treatment in cardiogenic shock patients. Anecdotal evidence is available about the use of ventricular assist devices, cardiac resynchronization therapy, and emergent heart transplantation.     

Cardiogenic shock

Cardiogenic shock is a pathophysiologic cascade that often leads to death. Although there has been a dramatic decrease in the cases of cardiogenic shock since the 1970s, the mortality rate of those patients who are diagnosed with cardiogenic shock remains as high as 50% to 80%. As stated throughout the article, cardiogenic shock in its later stages cannot be reversed, but clinical signs and symptoms of the syndrome may be identified early enough to prevent a patient from developing irreversible end-stage cardiogenic shock. As a prehospital care provider, you must be able to ensure the pre-shock patient has adequate oxygenation of the myocardium and can be effectively treated before it is too late.     

Cardiogenic shock

Cardiogenic shock remains a significant issue and affects 5% to 10% of patients admitted with an AMI. Mortality remains high despite advances in treatment for AMI. These patients are best treated in centers where they can receive treatment that follows the joint guidelines recommended by ACC and AHA. Rapid reperfusion therapy as well as pharmacologic and mechanical circulatory support provide the best options for survival.     

Cardiogenic shock

Some therapies used to treat cardiogenic shock may actually increase myocardial damage. An aggressive approach to monitoring and managment can help to identify correctable contributing events and evaluate therapies currently in use.     

Cardiogenic shock.

Mortality rates in patients with cardiogenic shock remain frustratingly high. Its pathophysiology involves a downward spiral in which ischemia causes myocardial dysfunction, which in turn worsens ischemia. Areas of viable but nonfunctional myocardium can contribute to the development of cardiogenic shock. Rapid diagnosis and prompt initiation of supportive therapy to maintain blood pressure and cardiac output, followed by expeditious coronary revascularization, are crucial. The SHOCK multicenter randomized trial has provided important new data that support a strategy of emergent cardiac catheterization and revascularization with angioplasty or coronary surgery when feasible. This strategy can improve survival and represents standard therapy at this time. In hospitals without direct angioplasty capability, stabilization with IABP and thrombolysis followed by transfer to a tertiary care facility may be the best option.     

Cardiogenic shock in hypothyroidism

A patient with minimal coronary artery disease presented in cardiogenic shock when her previously undiagnosed hypothyroid state was complicated by an episode of AV nodal re-entrant tachycardia. She did not respond to multiple pressors, and recovered dramatically after starting thyroid supplementation. Hypothyroidism caused her lack of responsiveness to pressors and perpetuated her hypotension and increased filling pressures long after she reverted to a sinus rhythm. Our case dramatically demonstrates the severe lack of physiologic reserve that can be associated with hypothyroidism.     

Cardiogenic and hypovolemic shock

The symptoms, signs, and pathophysiology of two major forms of shock are discussed. Newer modalities of pharmacologic and supportive therapy for stabilization and reversal of these states are presented, including the use of the intra-aortic balloon pump and early surgical therapy for cardiogenic shock.     

Cardiogenic shock complicating myocardial infarction

Cardiogenic shock is the primary cause of death among patients hospitalized with acute myocardial infarction. It is defined as tissue hypoperfusion resulting from ventricular pump failure in the presence of adequate intravascular volume. These patients need rapid assessment and appropriate institution of supportive therapies including vasopressor and inotropic agents, ventilatory support, and intra-aortic balloon pump counterpulsation. Emergency coronary artery revascularization is the only therapy that reduces mortality, and this should be provided early to patients to achieve maximal benefit, unless further care is deemed futile. Whereas newer support devices can provide better hemodynamic augmentation, their impact on mortality is limited. Novel therapies are needed to further decrease mortality rates, which remain high despite reperfusion therapy.     

实验性牙周炎大鼠模型的建立

背景:建立实验性牙周炎大鼠模型是研究牙周病的基本方法之一,目前常用的建模方法存在许多弊端,需要进一步改进。目的:建立一种近似于人类临床的牙周炎动物模型方法。方法:将20只8周龄的Wistar大鼠随机分为实验组和对照组,锐分离实验组大鼠双侧下颌第一磨牙颊侧牙龈,局部黏结慢性牙周炎患者的牙石于牙颈部,滴入慢性牙周病炎患者的唾液10μL/次,2次/d;对照组大鼠牙齿不做处理。两组大鼠均喂以高糖黏性食物。结果与结论:造模14d后实验组动物一般生物学特征和牙周组织病理、X射线变化均符合典型牙周炎表现。局部黏结牙石加混合细菌感染的方法建立的大鼠牙周炎模型可以模拟人类牙周炎的组织变化,是一种接近于人类临床的简单、实惠、有效的建模方法。     

实验性牙周炎大鼠模型的建立

背景：建立实验性牙周炎大鼠模型是研究牙周病的基本方法之一,目前常用的建模方法存在许多弊端,需要进一步改进。目的：建立一种近似于人类临床的牙周炎动物模型方法。方法：将20只8周龄的Wistar大鼠随机分为实验组和对照组,锐分离实验组大鼠双侧下颌第一磨牙颊侧牙龈,局部黏结慢性牙周炎患者的牙石于牙颈部,滴入慢性牙周病炎患者的唾液10μL/次,2次/d;对照组大鼠牙齿不做处理。两组大鼠均喂以高糖黏性食物。结果与结论：造模14d后实验组动物一般生物学特征和牙周组织病理、X射线变化均符合典型牙周炎表现。局部黏结牙石加混合细菌感染的方法建立的大鼠牙周炎模型可以模拟人类牙周炎的组织变化,是一种接近于人类临床的简单、实惠、有效的建模方法。