Dubey Laxman, Sharma Sanjib, Gautam Mani, Gautam Samir, Guruprasad Sogunuru, Subramanyam Gangapatnam
Department of Cardiology, College of Medical Sciences & Teaching Hospital, Bharatpur, Nepal.
Acta Cardiol. 2011 Dec;66(6):691-9. doi: 10.1080/ac.66.6.2136951.
Cardiogenic shock is characterized by inadequate tissue perfusion due to cardiac dysfunction and is the leading cause of death in patients hospitalized with acute myocardial infarction. Mortality from cardiogenic shock still remains high. The development of cardiogenic shock is rarely unexpected; most patients who develop cardiogenic shock do so within 48 hrs of admission, with only 10% shocked on arrival. Mortality rate is exceedingly high and reaches 70-80% in those treated conservatively. Early revascularization is the cornerstone treatment of acute myocardial infarction complicated by cardiogenic shock. According to the guidelines, revascularization is effective up to 36 hours after the onset of cardiogenic shock and performed within 18 hours after the diagnosis of cardiogenic shock. Primary percutaneous coronary intervention is the most efficient therapy to restore coronary flow in the infarct-related artery. However, invasive strategy in a developing country like ours is not only costly but also technically demanding. We present a case of acute myocardial infarction complicated with cardiogenic shock that underwent primary percutaneous coronary intervention and also review the incidence, pathophysiology, management and outcome of cardiogenic shock complicating acute myocardial infarction.
心源性休克的特征是由于心脏功能障碍导致组织灌注不足，是急性心肌梗死住院患者的主要死亡原因。心源性休克的死亡率仍然很高。心源性休克的发生很少是意外的；大多数发生心源性休克的患者在入院后48小时内出现，只有10%在入院时即处于休克状态。保守治疗的死亡率极高，达到70-80%。早期血运重建是急性心肌梗死合并心源性休克的基石治疗方法。根据指南，血运重建在心源性休克发作后36小时内有效，并在诊断心源性休克后18小时内进行。直接经皮冠状动脉介入治疗是恢复梗死相关动脉冠状动脉血流的最有效疗法。然而，在我们这样的发展中国家，侵入性策略不仅成本高昂，而且技术要求也很高。我们报告一例急性心肌梗死合并心源性休克患者接受直接经皮冠状动脉介入治疗的病例，并综述急性心肌梗死合并心源性休克的发生率、病理生理学、管理及结局。
