[Cardiogenic shock-- new therapeutic strategies].
BACKGROUND
Cardiogenic shock is a condition associated with high mortality. The evidence base for choice of treatment is insufficient, but new therapeutic options and new understanding have lead to some improvement in the prognosis. A new class of heart failure medication is now approved in Norway (calcium sensitizers).


METHODS
We present a case history that illustrates new options in the treatment of cardiogenic shock complicating acute myocardial infarction. We have searched available literature and give a review of the treatment of cardiogenic shock with special emphasis on the role of inotropic drug therapy.


CONCLUSIONS
A 46-year-old man with cardiogenic shock complicating myocardial infarction because of occlusion of the left-main coronary artery was treated with acute revascularization, intra-aortic balloon counterpulsation (IABP) and levosimendan. Early revascularization is a key factor in the treatment of cardiogenic shock; rapid transfer of patients to a revascularization centre is recommended. IABP should be considered after successful revascularization because of post-ischaemic dysfunction that persists despite restoration of epicardial blood flow. Beta-adrenergic stimulation of the heart should, if possible, be avoided, because of increased myocardial oxygen requirement, calcium overload of the cardiomyocytes, and increased mortality. Drug therapy using calcium sensitizers is promising, but more controlled clinical trials are needed.
Andersen
Geir Øystein
GØ
Hjerte-lunge-senteret og Farmakologisk institutt, Universitetet i Oslo. g.o.andersen@labmed.uio.no
Eritsland
Jan
J
Bjørnerheim
Reidar
R
Kløw
Nils-Einar
NE
Jonassen
Alf
A
Mangschau
Arild
A
D002316:Cardiotonic Agents / Q000627:therapeutic use; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D009204:Myocardial Revascularization; D011724:Pyridazines / Q000627:therapeutic use; D012770:Shock, Cardiogenic / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D000077464:Simendan
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan