Current Concepts and New Trends in the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction

Abstract

Cardiogenic shock (CS) is a critical condition which often complicates the evolution of an acute myocardial infarction (AMI). At the same time, co-existence of chronic multi-vessel disease can lead to the development of cardiogenic shock in cases with pronounced haemodynamic instability. Different clinical studies have tried to identify the most appropriate treatment for critical cases of CS complicating AMI. This review aims to present the current status of recommended therapeutic strategies for severe cases of CS presenting as a complication of AMI, and try to shed light on the most appropriate therapeutic strategy as outlined in the current literature. The paper will discuss the different current strategies available for use in the treatment of this condition, includig interventional revascularisation, (complete or culprit), the role of new devices for providing mechanical circulatory support, and the potential role of new drug therapies and of hypothermia.

SIRS Triggered by Acute Right Ventricular Function, Mimicked Septic Shock

“…Our patient also had normal serial troponins and ECGs, which does not support myocardial infarction-induced cardiogenic shock and SIRS, and sepsis-related myocardial dysfunction [9][10]. Cardiogenic shock mainly arises from left ventricular dysfunction and rarely from right ventricular function [11]. Milrinone, as a bipyridine phosphodiesterase (PDE)-3 inhibitor, improves RV contractility and reduces pulmonary vascular resistance (PVR) by vasodilation.…”

Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

“…In the setting of an AMI, cardiogenic shock is associated with high mortality when emergency circulatory support is not initiated in a timely and efficient manner [56,57]. In these critical cases, ECPR can serve as a bridge to transplantation, to implantation of a longterm assist device or to recovery, while insertion of an intra-aortic balloon pump can provide additional haemodynamic support during the bridging period.…”

Acute Thrombosis of the Left Main on the Tennis Court in a Young Patient – a Case Report

“…The leading cause of death in patients hospitalized for acute myocardial infarction (AMI) is cardiogenic shock (CS). 1 Many studies indicate a significant survival benefit at six months after early revascularization. Especially for patients with AMI complicated by CS, primary percutaneous coronary intervention (PCI) should be strongly considered and may be life-saving.…”

“…5 At the same time, in young patients suffering an AMI, CS is frequently associated, requiring a rapid diagnosis and supportive therapy. 1 Despite significant advances in device-based and pharmacological therapies for CS, the mortality associated with this critical condition has not improved significantly over the past 20 years. [5][6][7] However, an efficient management, consisting in early stabilization and immediate repermeabilization (with fibrinolytic therapy or percutaneous intervention), has been shown to reduce the mortality associated with this severe condition.…”