Brener Michael I, Rosenblum Hannah R, Burkhoff Daniel
COLUMBIA UNIVERSITY MEDICAL CENTER, NEW YORK, NEW YORK.
CARDIOVASCULAR RESEARCH FOUNDATION, NEW YORK, NEW YORK.
Methodist Debakey Cardiovasc J. 2020 Jan-Mar;16(1):7-15. doi: 10.14797/mdcj-16-1-7.
Cardiogenic shock (CGS) is common and highly morbid. According to the National Inpatient Sample, there are more than 100,000 cases per year, and 30-day mortality approaches 50% despite improvements in critical care practices and novel mechanical therapies targeted at restoring normal hemodynamics. This issue aims to enhance clinicians' understanding of CGS, and this review specifically focuses on the underlying pathophysiology. We examine the definition and etiologies of CGS, approaches to risk assessment, and the pressure-volume loop framework that is the foundation for conceptualizing ventricular mechanics, ventricular-vascular interactions, and the derangements observed in CGS. This overview will also contextualize subsequent chapters that discuss nuances of CGS encountered in particular scenarios (ie, post-myocardial infraction, acutely decompensated chronic heart failure, post-cardiac surgery), address pharmacological and mechanical treatments for CGS, and review CGS in a case-based format.
心源性休克(CGS)很常见且致死率很高。根据全国住院患者样本,每年有超过10万例病例,尽管重症监护实践和旨在恢复正常血流动力学的新型机械疗法有所改进,但30天死亡率仍接近50%。本期旨在增进临床医生对CGS的理解,本综述特别关注其潜在的病理生理学。我们研究了CGS的定义和病因、风险评估方法,以及压力-容积环框架,该框架是理解心室力学、心室-血管相互作用以及CGS中观察到的紊乱情况的基础。本概述还将为后续章节提供背景信息,后续章节将讨论在特定情况下(即心肌梗死后、急性失代偿性慢性心力衰竭、心脏手术后)遇到的CGS细微差别,介绍CGS的药物和机械治疗方法,并以病例形式回顾CGS。