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Cardiology
Acute Myocardial Infarction Complicated by Cardiogenic Shock
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
7 sections · 87 slides
Overview
- Scope of this presentation
Definition and burden
- Burden of cardiogenic shock in AMI
- Diagnostic criteria for cardiogenic shock
- Potential aetiologies of cardiogenic shock
- Causes of cardiogenic shock
- Mechanisms of circulatory collapse in AMI-CS
- Risk factors for developing AMI-CS
- Independent predictors of mortality in AMI-CS
Pathophysiology
- Extent of myocardial loss required for shock
- The ischaemic spiral in cardiogenic shock
- Neurohormonal response to hypoperfusion
- Pathophysiology of cardiogenic shock
- Systemic inflammatory response in cardiogenic shock
- Right ventricular cardiogenic shock
- Clinical setting of right ventricular infarction
- Ventricular phenotypes of cardiogenic shock
- Clinical and haemodynamic profiles of RV, LV and biventricular shock
Staging and assessment
- SCAI classification of cardiogenic shock
- SCAI stages A and B
- SCAI stages C, D and E
- Clinical features, mortality and treatment by SCAI shock stage
- History and physical examination
- Perfusion and congestion profiles
- Electrocardiogram in AMI-CS
- Laboratory testing in cardiogenic shock
- Echocardiography in cardiogenic shock
- Invasive haemodynamic monitoring
- Haemodynamic indices of right ventricular failure
- Evidence for pulmonary artery catheter use
Stabilization and revascularization
- Aims of vasoactive therapy
- Inopressors and inodilators
- Vasopressors and inotropes used in shock
- SOAP II trial: dopamine versus noradrenaline
- OptimaCC trial: adrenaline versus noradrenaline
- DOREMI trial: milrinone versus dobutamine
- Multidisciplinary shock teams
- Variables in designing an effective shock team
- Hub-and-spoke systems of care
- National Cardiogenic Shock Initiative algorithm
- SHOCK trial and early revascularization
- Non-culprit PCI in AMI-CS
Temporary mechanical circulatory support
- Growth and role of temporary MCS
- Temporary mechanical circulatory support devices
- Principle of intra-aortic balloon counterpulsation
- Determinants of intra-aortic balloon pump efficacy
- Limitations and trial evidence for the IABP
- Microaxial flow pumps: design and position
- Impella platform and haemodynamic effect
- DanGer Shock trial
- Veno-arterial ECMO in AMI-CS
- ECLS-SHOCK trial
- ARREST trial in refractory out-of-hospital cardiac arrest
- Why ECMO trials and observational data diverge
- Left ventricular loading on peripheral V-A ECMO
- Pressure-volume characteristics of mechanical support devices
- Benefits of left ventricular unloading
- Methods of left ventricular unloading
- Evidence and ongoing trials in LV unloading
Monitoring, escalation and complications
- Monitoring the patient on temporary MCS
- Anatomical factors in the decision to escalate
- Recognising inadequate right-sided support
- Complications of temporary MCS
- Management of bleeding after tMCS insertion
- Echocardiographic surveillance on V-A ECMO
- Troubleshooting the microaxial flow pump
- Surveillance for haemolysis
- Infection during temporary MCS
- Anticoagulation targets on mechanical support
- Acute limb ischaemia and distal perfusion catheters
- Future small-bore support devices
- Summary of AMI-CS management
- Practice points
- References
- References (continued)
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- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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