Document Detail

Cardiogenic shock. Current concepts in management.
MedLine Citation:
PMID:  3780474     Owner:  NLM     Status:  MEDLINE    
This article presents a categorisation of circulatory shock and discusses the causes, haemodynamics, and clinical recognition of cardiogenic shock. The first step in the management strategy in cardiogenic shock is to guide the patient from the state of shock to one of managed haemodynamic stability. The therapeutic manoeuvres of this first step constitute the management tactics, which can be grouped under 3 general headings: (a) making the most of a malfunctioning heart; (b) improving the state of the heart; and (c) reducing the demands on the heart. In order to make the most of the heart, i.e. to get the highest possible output at the lowest possible cost, clinicians need to use their judgement in stimulating an overtaxed heart on the one hand, and in manipulating the loads on it (the preload and afterload) on the other, for although these methods may be advantageous, they are not without their pitfalls. Efforts to improve the state of the heart often necessitate surgical (e.g. mitral valve replacement) or semisurgical (e.g. coronary angiography and recanalisation) techniques, although intravenous antithrombotic agents may achieve comparable results in a few cases at the bedside. Reducing the demands on the heart is an active process involving the takeover of at least a part of the work of the heart by ancillary devices such as the intra-aortic balloon pump, and of the work of breathing by intubation and artificial ventilation. The individuality of each case of cardiogenic shock emphasises the need for empirical modulation of therapy based on feedback information obtained by haemodynamic monitoring.
K Balakumaran; P G Hugenholtz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Drugs     Volume:  32     ISSN:  0012-6667     ISO Abbreviation:  Drugs     Publication Date:  1986 Oct 
Date Detail:
Created Date:  1986-12-31     Completed Date:  1986-12-31     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7600076     Medline TA:  Drugs     Country:  NEW ZEALAND    
Other Details:
Languages:  eng     Pagination:  372-82     Citation Subset:  IM    
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MeSH Terms
Cardiac Surgical Procedures
Cardiotonic Agents / therapeutic use
Intra-Aortic Balloon Pumping
Respiration, Artificial
Shock, Cardiogenic / physiopathology,  therapy*
Reg. No./Substance:
0/Cardiotonic Agents

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