Cardiogenic shock (CS) is a leading cause of mortality worldwide. CS presentation and management in the current era have been widely depicted in epidemiological studies. Its treatment is codified and relies on medical...Cardiogenic shock (CS) is a leading cause of mortality worldwide. CS presentation and management in the current era have been widely depicted in epidemiological studies. Its treatment is codified and relies on medical care and extracorporeal life support (ECLS) in the bridge to recovery, chronic mechanical device therapy, or transplantation. Recent improvements have changed the landscape of CS. The present analysis aims to review current medical treatments of CS in light of recent literature, including addressing excitation–contraction coupling and specific physiology on applied hemodynamics. Inotropism, vasopressor use, and immunomodulation are discussed as pre-clinical and clinical studies have focused on new therapeutic options to improve patient outcomes. Certain underlying conditions of CS, such as hypertrophic or Takotsubo cardiomyopathy, warrant specifically tailored management that will be overviewed in this review.展开更多
The use of beta(β)-blockers during septic shock aimed at countering peripheral adrenergic stress may be justified by the early reduction in deleterious effects resulting from sympathetic overactivation,and could impr...The use of beta(β)-blockers during septic shock aimed at countering peripheral adrenergic stress may be justified by the early reduction in deleterious effects resulting from sympathetic overactivation,and could improve the prognosis of patients in septic shock.Animal studies have demonstrated either a maintenance or increase in cardiac output(CO)despite the decrease in heart rate(HR)associated with improved myocardial performance.The mechanism by which𝛽-blockers alter hemodynamics in septic shock is debated;however,preclinical and clinical data show that𝛽-blockers are safe when started at a low dose.Recent publications(2019-2021)on adrenergic𝛽1 receptor antagonists used in septic shock indicate that esmolol and landiolol should not be used in the early phase.While there is no optimal timing for their administration,a minimum of 12 h after the initiation of vasopressor therapy in stabilized euvolemic patients is a reasonable option.Patients should have a normal cardiac function,although a slight depression is compatible with landiolol use under hemodynamic monitoring.Slow titration in patients who remain tachycardic is preferable to rapid titration.When used to decrease HR,landiolol is also effective in reducing the incidence of new arrhythmias.Results of a well-performed and well-powered randomized controlled trial(RCT)demonstrating a positive effect on survival-or at least on hard surrogates such as the incidence/duration of organ failure-are pending.展开更多
文摘Cardiogenic shock (CS) is a leading cause of mortality worldwide. CS presentation and management in the current era have been widely depicted in epidemiological studies. Its treatment is codified and relies on medical care and extracorporeal life support (ECLS) in the bridge to recovery, chronic mechanical device therapy, or transplantation. Recent improvements have changed the landscape of CS. The present analysis aims to review current medical treatments of CS in light of recent literature, including addressing excitation–contraction coupling and specific physiology on applied hemodynamics. Inotropism, vasopressor use, and immunomodulation are discussed as pre-clinical and clinical studies have focused on new therapeutic options to improve patient outcomes. Certain underlying conditions of CS, such as hypertrophic or Takotsubo cardiomyopathy, warrant specifically tailored management that will be overviewed in this review.
文摘The use of beta(β)-blockers during septic shock aimed at countering peripheral adrenergic stress may be justified by the early reduction in deleterious effects resulting from sympathetic overactivation,and could improve the prognosis of patients in septic shock.Animal studies have demonstrated either a maintenance or increase in cardiac output(CO)despite the decrease in heart rate(HR)associated with improved myocardial performance.The mechanism by which𝛽-blockers alter hemodynamics in septic shock is debated;however,preclinical and clinical data show that𝛽-blockers are safe when started at a low dose.Recent publications(2019-2021)on adrenergic𝛽1 receptor antagonists used in septic shock indicate that esmolol and landiolol should not be used in the early phase.While there is no optimal timing for their administration,a minimum of 12 h after the initiation of vasopressor therapy in stabilized euvolemic patients is a reasonable option.Patients should have a normal cardiac function,although a slight depression is compatible with landiolol use under hemodynamic monitoring.Slow titration in patients who remain tachycardic is preferable to rapid titration.When used to decrease HR,landiolol is also effective in reducing the incidence of new arrhythmias.Results of a well-performed and well-powered randomized controlled trial(RCT)demonstrating a positive effect on survival-or at least on hard surrogates such as the incidence/duration of organ failure-are pending.
