[Catecholamine therapy in cardiogenic shock: helpful, useless or dangerous?].
Cardiogenic shock is characterized by inadequate organ and tissue perfusion, due to cardiac dysfunction, predominantly following acute myocardial infarction. Mortality rates for patients with cardiogenic shock remain high, ranging from 50-70 % despite effective therapy. Rapid diagnostics, aggressive therapeutic approach (invasive or surgical revascularisation) and pharmacological support are currently used to improve the clinical outcome and survival. In the first line commonly sympathomimetics like dopamine, dobutamine, epinephrine and norepinephrine are used for the pharmacological treatment. They have a high affinity for alpha- and beta adrenergic receptors, leading to a positive inotropic cardiac function, an increase in heart rate, oxygen enhanced demand, and an increase in vasoconstriction. However, there are also some disadvantages in the use of sympathomimetics in patients with cardiogenic shock. Clearly, metabolic acidosis due to the increased oxygen demand can be observed. Vasoconstriction induced by sympathomimetics can lead to perfusion mismatch or even deficit within the microcirculation. Additionally, in some studies which give evidence that the use of sympathomimetics can directly lead to enhanced systemic inflammatory response due to an increased IL-6 expression. However, sympathomimetics are still first line therapeutics for treatment of cardiogenic shock -- with respect to dosage and duration of treatment.
Schwertz
H
H
Medizinische Universitätsklinik und Poliklinik III, Klinikum der Medizinischen Fakultät, Martin Luther-Universität Halle-Wittenberg, Halle/Saale.
Müller-Werdan
U
U
Prondzinsky
R
R
Werdan
K
K
Buerke
M
M
D000367:Age Factors; D000368:Aged; D002395:Catecholamines / Q000009:adverse effects / Q000627:therapeutic use*; D004298:Dopamine / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004837:Epinephrine / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D018482:Muscle, Skeletal / Q000473:pathology; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D010100:Oxygen / Q000378:metabolism; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000209:etiology; D015398:Signal Transduction / Q000187:drug effects; D016019:Survival Analysis; D013997:Time Factors
D002395:Catecholamines; D010100:Oxygen; D004298:Dopamine; D004837:Epinephrine
Katecholamine im kardiogenen Schock: hilfreich, nutzlos oder gefährlich?