Management of Cardiogenic shock in the era of new classification
Presenter
Nawaf Okleh, HMC Heart Hospital, Doha, Qatar
Nawaf Okleh, HMC Heart Hospital, Doha, Qatar
Title
Management of Cardiogenic shock in the era of new classification Introduction
Cardiogenic shock still challenging for cardiologist despite the improvement in coronary intervention Clinical Case
Our patient is a 54 male, with history of diabetes mellitus, hypertension, smoking, occasional alcohol intake. Presented with 3 hours history of chest pain, Electrocardiogram Anterior ST elevation myocardial infarction. On arrival to emergency department the chest pain was 5 out of 10 in severity, BP was 110/60 heart rate 105 beat per minutes, physical exam was normal. intervention Coronary angiography performed within less than 60 minutes of arrival, revealed 3 vessel disease and primary percutaneous coronary intervention was performed to proximal LAD. The patient developed pulmonary edema, so he was intubated, laboratory test showed lactic acid of 2.7mmol/l, right heart cath revealed cardiac revealed, cardiac output of 2.36L/min, cardiac index 1.2 L/min/m, systemic vascular resistance SVR 2102 Dynes.sec.cm-5, cardiac power output CPO 0;47 Watt and pulmonary arterial Pulsatility index PAPI was 0.93.Intra-aortic balloon pump inserted with intravenous nitroglycerin, after half an hour the cardiac output increased to 4.7l/min. The patient was transferred to intensive care unit with IABP. Few hours later the patient became hypotensive nitroglycerin discontinue and a small dose of Norepinephrine initiated. within three days the IABP was removed and the patient was extubated. Discussion
the utilize of new classification for cardiogenic shock should draw the attention early for patient at risk of shock and emphasize the use of hemodynamic monitoring and mechanical support.