Management of cardiogenic shock complicating ST-segment elevation myocardial infarction: part 1
Abstract
Cardiogenic shock associated with ST-segment elevation myocardial infarction (STEMI) is a potentially devastating complication. This type of shock consists of left ventricular dysfunction causing haemodynamic instability and end-organ hypoperfusion resulting in multi-organ dysfunction syndrome. Despite advances in the management of STEMI, especially in the realm of reperfusion strategies, mortality rates remain high. The pathophysiology is complex and multifactorial, resulting in a clinical presentation of hypotension and signs of hypoperfusion. Patient assessment comprises a targeted history and a thorough physical examination to detect signs of decompensation and end-organ hypoperfusion. Upon arrival in hospital, an echocardiograph is essential in the process of identifying a cause.
Learning Outcomes
After completing this module the paramedic will be able to:
Define cardiogenic shock Understand the pathophysiology of a person in cardiogenic shock Recognise the clinical presentation and features of cardiogenic shock Understand patient assessment of a person who appears to be in cardiogenic shock
Despite advances in revascularisation strategies, dual antiplatelet therapy and intravenous anti-thrombotic therapies, cardiogenic shock complicating ST-segment elevation myocardial infarction (STEMI) remains an unresolved medical challenge (Werden et al, 2014)—and the leading cause of mortality in the STEMI population.
De Backer et al (2010) report that next to septic shock, cardiogenic shock is the most common reason for intensive care admissions. Hasdai et al (2000) comment that it is associated with more than 40% acute reduction in left ventricular function. Such a reduction in left ventricular function presents as haemodynamic instability, end-organ hypoperfusion and the development of multi-organ dysfunction syndrome, which may lead to death. Multi-organ dysfunction syndrome is characterised by more than one vital organ dysfunction and is associated with a systemic inflammation process (Parke et al, 2003).
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