Cardiogenic Shock

Moskovitz, Joshua B.; Levy, Zachary David; Slesinger, Todd

doi:10.1016/j.emc.2015.04.013

Cited by 3 publications

(5 citation statements)

References 31 publications

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“…Regarding the value of biomarkers to gauge the prognosis of such patients, it should be noted that the main mechanism of hyperlactatemia is related to the development of anaerobic metabolism [ 3 , 20 , 21 ]. The assessment of lactates in patients with shock has been performed for > 30 years [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry

et al. 2020

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Refractory cardiogenic shock (RCS) or refractory cardiac arrest (RCA) complicating acute coronary syndrome (ACS) is associated with extremely high mortality rate. Veno-arterial extracorporeal life support (VA-ECLS) represents a valuable therapeutic option to stabilize patients' condition before or at the time of emergency revascularization. We analyzed 29 consecutive patients with RCS or RCA complicating ACS, and implanted with VA-ECLS in two centers who have adopted a similar, structured approach to ECLS implantation. Data were collected from January 2010 to December 2015 and ECLS had to be percutaneously implanted either before (within 48 h) or at the time of attempted percutaneous coronary revascularization (PCI). We investigated in-hospital outcome and factors associated with survival. Twenty-one (72%) were implanted for RCA, whereas 8 (28%) were implanted on ECLS for RCS. All RCA were witnessed and no-flow time was shorter than 5 min in all cases but one. All patients underwent attempted emergency PCI, using radial access in ten cases (34.5%), whereas in three patients a subsequent CABG was performed. Overall, ten patients (34.5%) survived, nine of them with a good neurological outcome. Life threatening complications, including stroke (4 pts), leg ischemia (4 pts), intestinal ischemia (5 pts), and deep vein thrombosis 2 pts), occurred frequently, but were not associated with in-hospital death. Main cause of death was multiorgan failure. PCI variables did not predict survival. Survivors were younger, with shorter low-flow time, and with ECLS mainly implanted for RCS. At multivariate analysis, levels of lactate at ECLS implantation (OR 4.32, 95%CI 1.01-18.51, p = 0.049) emerged as the only variable that independently predicted survival. In patients with RCA or RCS complicating ACS who are percutaneously implanted with ECLS before or at the time of coronary revascularization, in hospital survival rate is higher than 30%. Level of lactate at ECLS implantation appears to be the most important factor to predict survival.

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Section: Discussionmentioning

confidence: 99%

Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry

et al. 2020

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“…The most common cause is acute myocardial infarction but other causes include sinoatrial bradycardia from vagal stimulation, increased intra-cranial pressure, vasodepressor syncope, complete A-V block, esophageal diverticulum and carotid sinus stimulation. 4,5 In this case we report a challenging diagnosis in a woman with giant goiter and some symptoms mimicking hypothyroidism, but after thyroid hormones test report normal values and with the fast clinical deterioration, another sources of this symptoms were analyzed and cardiac shock suspected as the source of symptoms, with carotid sinus compression as the most logic origin. Immediate improvement of clinical course after urgent thyroidectomy confirms our suspect and fortunately the patients have not any complication and could be discharged uneventfully.…”

Section: Discussionmentioning

confidence: 99%

Cardiogenic Shock Secondary to Thyroid Goiter Case Report

Andrade¹

2016

MOJCR

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Background: Thyroid goiter can appear in some developing countries, related with iodo deficiencies. The main complications associated with goiter is airway obstruction, but cardiogenic shocks have not been reported previously. Case:We report the case of a 59year-old woman who comes to general surgery consultation for an anterior cervical mass associated with weakness, fatigue, and relative incapacity to complete her activities. At physical exam a thyroid goiter was suspected and ultrasound confirms this. Symptomatology was attributed to thyroid function disturbance and hormonal levels of TSH, T3 and T4 were confirmed as normal. Preoperative evaluation by Internal Medicine service was requested. One week later patient come to this evaluation with increased symptomatology, pallor, bradycardia, tachypnea, and parents refers a syncope too. At physical exam she was diaphoretic, with Glasgow of 12 points, pallor, cardiac frequency of 40 beats per minute and arterial pressure of 80/40mmHg, yugular ingurgitation, dyspnea, tachypnea of 27 breaths per minute, diminished peripheral pulses and distal cyanosis. CT scan refers a compressive mass dependent of left thyroid hemisphere without occlusion of airway and we appreciate a compression of left carotid artery. Patient does not improve with medical management and a cardiogenic shock secondary to carotid sinus stimulation was suspected, reason why an emergency thyroidectomy was scheduled. Hemi-thyroidectomy was completed without complications and after 24hours' patient was recovered and asymptomatic, confirming our suspects. Conclusion:This case is a very rare presentation of multinodular thyroid goiter, without previous similar reports, but with high relevance to consider it in a similar scenario because the delate in urgent surgical management could worsen outcomes.

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“…Alterations in electrical activity are expected due to the potential damage to the atrioventricular and sinoatrial nodes. This is more often followed by supraventricular arrhythmias and sinoatrial or complete atrioventricular blocks [ 52 ]. Additionally, atrial flutter or fibrillation can also be present [ 47 ].…”

Section: Signs and Symptomsmentioning

confidence: 99%

“…Additionally, R:S ratio in lead V5 or V6 ≤ 1, S in lead V5-V6 ≥ 7 mm, P-pulmonale can be seen, with specificity thought to be between 83% and 95%. [ 39 , 46 ] P-pulmonale can be seen, with a specificity thought to be between 83% and 95% [ 47 , 52 ]. Patients with PE might show evidence of the ‘RV strain’, an incomplete right bundle branch block, an ‘S1Q3T3′ pattern and T-waves in V1 through V4, which are associated with an eightfold increased risk of mortality [ 40 ].…”

Section: Signs and Symptomsmentioning

confidence: 99%

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Keep the Right in Mind—A Focused Approach to Right Ventricle-Predominant Cardiogenic Shock

Copeland

Fardman

Furer

2023

Life

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Cardiogenic shock (CS) remains a highly lethal condition despite many efforts and new interventions. Patients presenting with a rapid onset of hemodynamic instability and subsequent collapse require prompt and appropriate multimodality treatment. Multiple etiologies can lead to heart failure and subsequent shock. As the case prevalence of heart failure increases worldwide, it is of great importance to explore all manners and protocols of presentation and treatment present. With research primarily focusing on CS due to cardiac left-sided pathology, few assessments of right-sided pathology and the subsequent clinical state and treatment have been conducted. This review aims to present an in-depth assessment of the currently available literature, assessing the pathophysiology, presentation and management of CS patients due to right heart failure.

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Cardiogenic Shock

Cited by 3 publications

References 31 publications

Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry

Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry

Cardiogenic Shock Secondary to Thyroid Goiter Case Report

Keep the Right in Mind—A Focused Approach to Right Ventricle-Predominant Cardiogenic Shock

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