Post Infarction Cardiogenic Shock: Is It Clinically Important to Differentiate Hemodynamic Patterns?

Yanina Castillo Costa, Víctor Mauro, Adrián Charask, Enrique Fairman, Jorge Leguizamón, Carlos Barrero


Despite recent advances in the treatment of cardiogenic shock, it still remains themain cause of death in patients hospitalized for acute myocardial infarction. Althoughcardiogenic shock is classically described as a hemodynamic condition characterizedby low cardiac output, increased filling pressure and elevated systemic vascular resistance,some patients present different patterns, as low systemic resistance, feverand leucocytosis, indicative of an important systemic inflammatory response. Theclinical importance of having one hemodynamic pattern or the other is currently unknown,though the existence of two different hemodynamic patterns should lead toreconsider the support medical treatment in this severely ill group of patients. Theaim of this work was to analyze the incidence of each type of cardiogenic shock (classicand distributive), its clinical characteristics and its in-hospital outcome.


Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al.Early revascularization in acute myocardial infarction complicated by cardiogenic shock. N Engl Med.1999;341:625-634.

Hochman J. Cardiogenic Shock Complicating Acute Myocardial Infarction: Expanding the Paradigm. Circulation. 2003;107:2998-3002.

Babaev A, Frederick PD, Pasta DLy cols. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 2005; 294:448-54.

Menon V, Hochman J, Stebbins A, Pfisterer A, Col J, et al. Lack of progress in cardiogenic shock: lessons from the GUSTO trials. Eur Heart J 2000;21:1928-1936.

ACC/AHA Guidelines for the management of patients with ST-Elevation Myocardial Infarction. Circulation 2004; 110:e82-e292.

Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Guías de Práctica Clínica de la Sociedad Europea de Cardiología (ESC). Manejo del infarto agudo de miocardio en pacientes con

elevación persistente del segmento ST. Rev Esp Cardiol. 2009;62(3):e1-e47 1e.

Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich H, Hausleiter J, et al. for the IABP-SHOCK II Trial. Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock. N Engl J Med 2012;367:1287-96.

Theroux P, Armstrong P, Mahaffey K, Hochman J, Malloy K, et al.Prognostic significance of blood markers of inflamation in patients with ST-elevation myocardial infarction undergoing primary angioplasty and effects of pexelizumab, a C5 inhibitor: A substudy of the COMMA trial. Eur Heart J; 2005:26:1964-70.

Zhang C, Xu X, Potter BJ, Wang W, Kuo L, et al. TNF-alpha contributes to endothelial dysfunction in ischemia/reperfusion injury. Arterioescler Thromb Vasc Biol. 2006;26: 475-80.

Reynolds H, Hochman J. Cardiogenic Shock:Current concepts and improving outcomes. Circulation 2008; 117:686-97.

Cotter G, Kaluski E, Blatt A, Milovanov O, Moshkovitz Y, Zaidenstein R, et al. L-NMMA (a Nitric Oxide Synthase Inhibitor) is effective in the treatment of cardiogenic shock. Circulation 2000;101:1358-61.

TRIUMPH Investigators, Effects of tilarginine acetato in patients with acute myocardial infarction and cardiogenic shock: The TRIUMPH randomized controlled trial. JAMA 2007; 297:1657-1666.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020