Cardiogenic Shock

Patho physiology: Cardiogenic shock is a condition in which your heart suddenly can't pump enough blood to meet your body's needs. The condition is most often caused by a severe heart attack. Cardiogenic shock is rare, but it's often fatal if not treated immediately. If treated immediately, about half the people who develop the condition survive.

Treatment: During this treatment, which most people who have cardiogenic shock need, you're given extra oxygen to breathe, to minimize damage to your muscles and organs. If necessary, you'll be connected to a breathing machine (ventilator). You'll receive medications and fluid through an intravenous (IV) line in your arm. Medications to treat cardiogenic shock work to improve blood flow through your heart and increase your heart's pumping ability such as Aspirin, Thrombolytics, Superaspirins, Other blood-thinning medications, Inotropic agents. Medical procedures to treat cardiogenic shock usually focus on restoring blood flow through your heart. They include: Angioplasty and stenting, Balloon pump. If medications and medical procedures don't work to treat cardiogenic shock, your doctor may recommend surgeries are Coronary artery bypass surgery, Surgery to repair an injury to your heart, Heart pumps, Heart transplant.

Research: The administration of an experimental agent known as TRO40303 to patients who have had a heart attack, with the hope of preventing tissue damage when impaired blood flow is corrected (reperfusion), was disappointingly ineffective according to results of a European study of patients with acute ST-elevation myocardial infarction (STEMI). Results for TRO40303 are a surprising contrast to promising earlier studies that had generated high hopes for the agent. "Negative studies rarely lead to phenomenal breakthroughs and monumental change-of-practice, but it is important to be aware that negative studies increase our understanding of disease and of therapeutic options," he said. The study's finding of lack of benefit of TRO40303, "provides important information on current state-of-the-art STEMI treatment, and may reflect the fact that the high quality of modern care leaves little room for improvement." TRO40303 has been shown in animals and laboratory models to block mitochondrial permeability that leads to reperfusion injury. When blocked vessels that cause a heart attack (infarct) are cleared, allowing reperfusion, cardiac muscle may be injured causing what is known as an infarct expansion. Mitochondrial permeability has been shown to play an important role in this process

Statistics: All the progress made in the treatment of myocardial infarction seems to have ground to a halt before these 5% to 10% of heart attack patients. In the SOAP II study of 1679 patients with shock of various etiologies (14), norepinephrine showed a tendency to lower mortality than dopamine 28-day mortality 45.9% vs. 50.2%; odds ratio [OR] 1.19; confidence interval [CI] 0.98 to 1.44; p = 0.07) and significantly fewer arrhythmias (12.4% vs. 24.1%), especially atrial fibrillation. In the prospectively de-fined subgroup of patients with cardiogenic shock, the norepinephrine treatment led to a significantly better survival rate than the dopamine treatment (OR 0.75; p = 0.03; [14]).