Page 81 - fbkCardioDiabetes_2017

Cardiogenic Shock: 57
Etiopathogenesis & Clinical Recognition

as in ruling out pneumothorax. An electrocardiogram III COLD- <2.2/<18 23 % 17 %
(ECG) reveals sinus tachycardia or underlying arrhyth- DRY
mias if any. Also it helps in detecting a coronary eti- IV COLD- <2.2/>18 51 % 40 %
ology by revealing exaggerated ST-T changes. Non- WET
specific findings in an ECG usually seen in cardiomy-
opathy are the diffuse low voltage complexes, mild (Table 2) : Forrester’s and Fonarow’s Prognostication
ST-T changes and conduction system abnormalities. of Heart Failure Based on Clinical Assessment
Evidence of primary cardiac failure has to be made Conclusion:
by 2D-echocardiography. Once an echocardiographic
documentation of myocardial pump failure is made, Cardiogenic shock is a clinical syndrome caused
investigations should be directed to rule out acute primarily by myocardial pump failure due to diverse
coronary syndromes with aid of an electrocardio- etiologies. The diagnosis of cardiogenic shock in a
gram. Acute MI presenting as cardiogenic shock patient suggests poor short term as well as long
should be offered early revascularization preferably term prognosis. Hence lays the importance of ear-
by percutaneous coronary interventions. Mechanical ly recognition and instituting appropriate therapy. In
circulatory support devices like Intra-Aortic Balloon spite of developments in management of cardiogenic
Pump or Extra-Corporeal Membrane Oxygenation shock, the mortality as well as rehospitalisation rates
may be offered to the sick patients in cardiogenic continue to be very high. Future research should be
shock. Similarly acute mechanical causes of cardio- directed towards unmet needs in the management
genic shock like acute mitral or aortic regurgitation of cardiogenic shock.
or ventricular septal rupture or free wall rupture need
to ruled out by echocardiography so that timely sur- References
gical interventions may be offered. One should have 1. Vincent JL, De Backer D. Circulatory shock. N Engl J Med 2013;
a high clinical suspicion of pulmonary embolism or 369:1726.
aortic dissection as etiologies of unexplained cardio- 2. Rodgers KG. Cardiovascular shock. Emerg Med Clin North Am 1995;
genic shock. CT should be offered to such patients to 13:793.
expedite the diagnosis of these conditions. 3. Califf RM, Bengtson JR. Cardiogenic shock. N Engl J Med. 1994;330:1724-
30.
Prognosis of Cardiogenic Shock: 4. Holmes DR Jr, Berger PB, Hochman JS, et al. Cardiogenic shock in
patients with acute ischemic syndromes with and without ST-segment
Hospital mortality rates range from 50-80% depend- elevation. Circulation 1999;100:2067–73.
ing on the etiology of cardiogenic shock and other
prognosticators like age, gender, comorbidities and 5. Hochman JS, Boland J, Sleeper LA, Porway M, Brinker J, Col J, et al.
Current spectrum of cardiogenic shock and effect of early revasculariza-
(11)
multi-organ involvement. Cardiogenic shock is the tion on mortality. Results of an International Registry. SHOCK Registry
leading cause of death in patients with acute MI Investigators. Circulation. 1995;91:873-81.
wherein the hospital mortality rates approach 50% in- 6. Handler CE. Cardiogenic shock. Postgrad Med J. 1985;61:705–12
spite of offering the best-of-care available. The 5 year
mortality is approximately 60%. (4) The ESC-HF pilot 7. Knobel E. Cardiogenic shock. Arq Bras Cardiol volume 72, (nº 4), 1999
(12)
study studied reveals that the 12 month all-cause 8. Barber AE, Shires GT. Cell damage after shock. New Horiz 1996; 4:161.
mortality and hospitalization rates for hospitalized 9. Forrester JS, Diamond GA, Swan HJC. Correlative classification of clin-
heart failure patients were 17% and 44% respectively. ical and hemodynamic function after acute myocardial infarction. Am
Forrester’s and Fonarow’s sub grouping (13) of cardio- J Cardiol 1977 Feb;39(2):137-45
genic shock based on hemodynamic characteristics 10. Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart fail-
also helps in assessing the in-hospital mortality out- ure: the Framingham Study. J Am Coll Cardiol. 1993 Oct. 22 (4 Suppl
comes A):6A-13A
11. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the
Stage Clinical Cardiac In-hos- 6 month diagnosis and treatment of acute and chronic heart failure: The Task
of Heart Recogni- Index pital hospital Force for the diagnosis and treatment of acute and chronic heart failure
Failure tion / PCW mortality mortality of the European Society of Cardiology (ESC) developed with the special
Pressure contribution of the Heart Failure Association (HFA) of the ESC. Eur
Heart J2016;37:2129-2200
I WARM- >2.2/<18 3 % 11 %
DRY 12. Maggioni A.P, Dahlstrom U, Filippatos G, et al. EURO observational
Research Programme: the Heart Failure Pilot Survey (ESC-HF Pilot) Eur
II WARM- >2.2/>18 9 % 22 % J Heart Fail, 12 (2010), pp. 1076-1084
WET
13. Fonarow G.C, Weber J.E. Assessment and treatment of acute heart
failure Clin. Cardiol. Vol. 27 (Suppl. V) September 2004

Cardio Diabetes Medicine