Management of cardiogenic shock due to acute coronary syndromes.
Despite advances in the treatment of patients with acute coronary syndromes, there has been no significant decrease in the incidence of cardiogenic shock, while its mortality remains frustratingly high. Shock is a progressive state of hypotension (systolic blood pressure < 90 mm Hg) lasting at least 30 minutes, which leads to systemic hypoperfusion. It is more common in patients with ST-segment elevation myocardial infarction than in patients with other acute coronary syndromes. Revascularization is associated with better outcomes than intensive medical therapy, especially in patients < 75 years of age with cardiogenic shock. Adjunctive therapies include inotropes, vasopressor therapy, intra-aortic balloon pump counterpulsation, and IIb/IIIa blockade to prevent no-reflow phenomenon during primary percutaneous transluminal coronary angioplasty. Other adjunctive therapies which are investigated are improved mechanical support devices, and as medical therapy for myocyte protection nicorandil, glucose/insulin/potassium infusions and direct inhibition of Na+/H+ exchanger.
Bouki
Konstantina P
KP
1st Department of Cardiology, General Hospital of Nikea, Pireaus, Greece. epapak@tee.gr
Pavlakis
Georgios
G
Papasteriadis
Evaggelos
E
D002316:Cardiotonic Agents / Q000627:therapeutic use; D003327:Coronary Disease / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D013577:Syndrome; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D002316:Cardiotonic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014662:Vasoconstrictor Agents