Thienel Manuela, Kaiser Rainer, Gmeiner Jonas, Orban Martin, Kääb Stefan, Petzold Tobias, Massberg Steffen, Scherer Clemens
Department of Cardiology, Ludwig-Maximilians-University Hospital, Ludwig Maximilians University, 81377 Munich, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, 80336 Munich, Germany.
J Clin Med. 2025 Jun 5;14(11):4011. doi: 10.3390/jcm14114011.
Cardiogenic shock is a life-threatening condition characterized by the failure of the heart to maintain adequate circulation, leading to multi-organ dysfunction. While it is most commonly associated with acute myocardial infarction or cardiomyopathies, cardiogenic shock can also arise in unusual settings, such as severe malnutrition in patients with anorexia nervosa, a psychiatric disorder characterized by extreme restriction of food intake. Here, we describe the management of three patients with anorexia nervosa and severe cardiogenic shock, who were treated in our cardiological intensive care unit between December 2022 and January 2025. Two patients were successfully resuscitated after experiencing cardiac arrest, and two required mechanical circulatory support, including Venoarterial Extracorporeal Membrane Oxygenation and microaxial flow pump. The patients presented with a range of complications including multi-organ failure and respiratory distress. Due to the fragile balance between intensive cardiac and nutritional management, as well as the comorbidity of chronic malnutrition, therapeutic decisions were made carefully, including cautious electrolyte management, targeted nutritional therapy, and the use of advanced circulatory support. : The treatment approach and beneficious outcomes underline the necessity of a multidisciplinary strategy in managing these critically ill patients with complex, interwoven pathologies. Our experience suggests that early recognition of cardiogenic shock and timely intervention with mechanical circulatory support may significantly improve patient survival in this high-risk cohort. Careful management of nutritional therapy and supplementation of trace elements and vitamins is crucial.
心源性休克是一种危及生命的病症，其特征是心脏无法维持足够的循环，导致多器官功能障碍。虽然它最常与急性心肌梗死或心肌病相关，但心源性休克也可能在不寻常的情况下出现，例如神经性厌食症患者的严重营养不良，这是一种以极度限制食物摄入为特征的精神疾病。在此，我们描述了2022年12月至2025年1月期间在我们的心脏重症监护病房接受治疗的三名神经性厌食症合并严重心源性休克患者的治疗情况。两名患者在心脏骤停后成功复苏，两名患者需要机械循环支持，包括静脉-动脉体外膜肺氧合和微型轴流泵。患者出现了一系列并发症，包括多器官衰竭和呼吸窘迫。由于强化心脏管理和营养管理之间的脆弱平衡，以及慢性营养不良的合并症，治疗决策谨慎做出，包括谨慎的电解质管理、针对性的营养治疗以及使用先进的循环支持。治疗方法和有益结果强调了多学科策略在管理这些患有复杂交织病理的重症患者中的必要性。我们的经验表明，早期识别心源性休克并及时进行机械循环支持干预可能会显著提高这一高危人群的患者生存率。精心管理营养治疗以及补充微量元素和维生素至关重要。
