["Catecholamine refractory" cardiogenic shock? "Bridging-to-recovery" by implantation of a percutaneous cardiac assist device]. / "Therapierefraktärer" kardiogener Schock? "Bridging-to-recovery" mittels Implantation eines perkutanen Assistdevices.
Dtsch Med Wochenschr
; 138(12): 576-80, 2013 Mar.
Article
em De
| MEDLINE
| ID: mdl-23483417
ABSTRACT
HISTORY AND ADMISSION FINDINGS:
A 27-year-old man presented with acute dyspnea and a previous respiratory tract infection with progressive dyspnoea and chest pain over 2 weeks. Clinical findings revealed severe cardiac failure with development of cardiogenic shock and need for adrenergic drug therapy for circulatory support. INVESTIGATIONS The electrocardiogram showed a sinus tachycardia with unspecific T-wave-inversions, the echocardiogram revealed a dilated left ventricle and severely reduced systolic LV-function. An acute coronary syndrome could be excluded by coronary angiogram. TREATMENT AND COURSE A myocardial biopsy was taken to exclude giant cell myocarditis. The immediate initiation of a mechanical circulatory support by an Extracorporal Membrane Oxygenator (ECMO) facilitated rapid hemodynamic stabilization and recovery of organ function.CONCLUSIONS:
A drug-only circulatory support very often does not enable stabilization of a patient in progressive cardiogenic shock and cannot prevent multiorgan dysfunction. Therefore implantation of an assist device facilitates a "bridging-to-recovery" or a "bridging-to transplant" concept in critically ill patients presenting with cardiogenic shock. The bridging also allows for reviewing etiology and evaluation of further treatment options. In case of recovery continuous care in a specialized Heart Failure Clinic can help to maintain the clinical status and offer frequent reevaluation of cardiac status and therapeutic concepts.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Choque Cardiogênico
/
Catecolaminas
/
Epinefrina
/
Coração Auxiliar
Idioma:
De
Ano de publicação:
2013
Tipo de documento:
Article