Actualización sobre choque cardiogénico

1. CHOQUE CARDIOGENICO

2. DEFINICION
• Acute cardiac hemodynamic instability may result from disorders that
impair function of the myocardium, valves, conduction system, or
pericardium, either in isolation or in combination.
• CS is pragmatically defined as a state in which ineffective cardiac
output caused by a primary cardiac disorder results in both clinical
and biochemical manifestations of inadequate tissue perfusion.
• Before the routine use of early revascularization, MI associated CS
had an in-hospital mortality exceeding 80%

4. EPIDEMIOLOGIA Y PRONOSTICO
• An analysis of the Nationwide Inpatient Sample Database between
2003 and 2010 reported an increase in the prevalence of CS from 6%
to 10% in the overall population and from 7% to 12% among patients
>75 years of age presenting with STEMI.4 In-hospital mortality
decreased from 45% to 34% over the same time frame, although
mortality rates remained high (55%) in patients >75 years of age.
• A small study comparing the APACHE-II, APACHE-III, SAPS-II, and SOFA
scoring systems in CS reported that APACHE-III and SAPS-II had the
best mortality discrimination
• Limitations of available models included the lack of a CS-specific
derivation population, external validation, dynamic application (ie,
single point in time only), applicability to all CS types, and capture of
all potentially prognostic clinical, laboratory, hemodynamic,imaging,
and biomarker data

5. • Among patients with ACS-associated CS who had revascularization
and who survived to hospital discharge, long-term follow-up of the
SHOCK trial suggests that the majority (62%) were alive 6 years later.
• Despite favorable longer-term survival, CS may be associated with
considerable morbidity.
• The SHOCK and IABP-SHOCK II trials have reported modest quality of
life among 1-year survivors, with New York Heart Association class II
to IV symptoms in 43% and self-care, physical, or psychological
impairments in ≈20% to 30%.

6. PATOGENESIS
• A contemporary registry has reported that as many as 81% of patients
presenting with CS had an underlying acute coronary syndrome (ACS).
• Chronic HF can present in an acute decompensated state and may
account for up to 30% of CS cases.
• Among patients who had cardiac surgery, 2% to 6% of patients
develop postcardiotomy shock.
• Numerous additional causes of CS have been reported, but they
typically occur in <1% of patients

8. FISIOPATOLOGIA

9. FENOTIPOS HEMODINAMICOS

10. EVALUACION

11. MANEJO