Echocardiographic assessment in cardiogenic shock
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Introduction Shock is a life-threatening, generalized type of circulatory failure linked with inadequate oxygen supply to the cells [1]. The diagnosis of shock includes the clinical signs of hypotension, poor peripheral perfusion determined by skin changes, especially cold, clammy, discolored skin, decreased urine output, and altered mental function. Four different pathophysiological mechanisms can result in shock [2, 3]. Hypovolemia, either absolute hypovolemia secondary to fluid losses or relative hypovolemia due to redistribution of fluids from central to peripheral compartments, results in a decrease in cardiac preload and hence in cardiac output. Obstructive shock results from compression of heart cavities from cardiac tamponade and tension pneumothorax or increase in right ventricular afterload (often from pulmonary embolism). Distributive/septic shock results from the impairment in vascular tone, associated with severe hypotension, venous dilation, altered distribution of perfusion between the different organs, as well as inside each organ (microvascular impairment) [1, 4]. Cardiogenic shock (CS) is a failure of pump function secondary to impaired contractility, severe valvular dysfunction, or severe arrythmias [2, 3]. If CS is not rapidly recognized and treated, tissue hypoperfusion can rapidly cause organ dysfunction and death [3]. Accurate identification of the type of shock might be challenging as all forms are characterized by arterial hypotension and impaired peripheral perfusion. Transthoracic echocardiography (TTE) serves as a useful tool in the man-
Sercan Okutucu1 · Sefik Gorkem Fatihoglu2 · Maximiliano Otero Lacoste3 · Ali Oto1 1
Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey Department of Cardiology, Iskenderun State Hospital, Hatay, Turkey 3 Department of Echocardiography, Americas Medical City and CopaStar Hospital, Rio de Janeiro, Brazil 2
Echocardiographic assessment in cardiogenic shock agement of shock, as it can differentiate the types of shock and prove the etiology in most patients with cardiogenic and obstructive shock [5, 6]. Additionally, echocardiography provides a noninvasive means for hemodynamic monitoring of patients, which is helpful in guiding the treatment. Herein, the authors conducted a literature search and reviewed the diagnostic role of echocardiography as a decision-making tool in the evaluation and management of CS.
Methods
and laboratory evidence of end-organ dysfunction in the setting of suspected cardiac dysfunction. The Society for Cardiovascular Angiography and Interventions (SCAI) recently proposed a new classification of CS in order to provide a simple scheme that appropriately differentiates patient subsets [3]. Acute myocardial infarction (MI) accounts for nearly 80% of all cases of CS [9]. In addition to acute MI, many other cardiac pathologies can also result in CS requiring consideration when dealing with shock patients. Common causes of CS are shown in . Table 1.
Search strategy and data collection A searchofthe PubMed database, Scopus, an
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