Barnett Christopher F, Brusca Samuel B, Hanff Thomas C, Blumer Vanessa, Kalif Adnan, Kanwar Manreet
Division of Cardiology, University of California, San Francisco, San Francisco, California, USA.
Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Can J Cardiol. 2023 Apr;39(4):406-419. doi: 10.1016/j.cjca.2023.01.023. Epub 2023 Jan 31.
Cardiogenic shock is an extreme manifestation of acute decompensated heart failure. Cardiogenic shock is often caused by-and has traditionally been studied in the setting of-acute myocardial infarction (AMI CS); however, there is increasing incidence and recognition of cardiogenic shock not associated with acute myocardial infarction (non-AMI CS) as a distinct entity. Despite decades of study and technologic advancements, cardiogenic shock mortality remains as high as 50%, regardless of etiology. New approaches to shock phenotyping and classification have emerged, with a focus on appropriately matching patient physiology to a growing list of available interventions. Further study is needed to determine whether these efforts will lead to more nuanced use of mechanical circulatory support and improved patient outcomes, especially in non-AMI CS. In the meantime, models of care incorporating multidisciplinary decision making, such as shock teams, may improve patient selection and outcomes.
心源性休克是急性失代偿性心力衰竭的一种极端表现形式。心源性休克通常由急性心肌梗死(急性心肌梗死所致心源性休克)引起,并且传统上也是在这种情况下进行研究;然而,作为一种独特的病症,与急性心肌梗死无关的心源性休克(非急性心肌梗死所致心源性休克)的发病率和认知度正在不断上升。尽管经过了数十年的研究和技术进步,但无论病因如何,心源性休克的死亡率仍高达50%。新的休克表型分析和分类方法已经出现,重点是使患者生理状况与越来越多的可用干预措施相匹配。需要进一步研究以确定这些努力是否会导致更细致地使用机械循环支持并改善患者预后,特别是在非急性心肌梗死所致心源性休克患者中。与此同时,纳入多学科决策的护理模式,如休克治疗团队,可能会改善患者的选择和预后。