Early revascularization, vasopressors and inotropes, fluids, mechanical circulatory support MCS , and general intensive care measures are widely used for CS management. However, there is only limited evidence for any of the above treatment strategies except for revascularization and the relative ineffectiveness of intra-aortic balloon pumping. In general, patients with CS should best be treated at specialized tertiary CS care centers. Revascularization should be limited to the culprit lesion with possible staged revascularization of other lesions at a later time point based on contemporary evidence.
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Cardiogenic shock - Wikipedia
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V1 and V2 vasopressin receptor agonist. Levy et al. To compare hemodynamic effects, lactate metabolism and impact on systemic perfusion of epinephrine and combined dobutamine-norepinephrine. Epinephrine and norepinephrine-dobutamine had similar hemodynamic effects Epinephrine associated with transient increase in lactate level and HR, and inadequate gastric mucosa perfusion. Myburgh et al. ICU patients requiring norepinephrine or epinephrine. Time to achieve MAP goals and day mortality.
No differences in any endpoints. Annane et al. Efficacy and safety of norepinephrine plus dobutamine vs. Patients diagnosed with septic shock. Similar mortality in both groups. To compare hemodynamic effects of dopamine and dobutamine in patients with CS. Dobutamine increased stroke index and CI more than dopamine. To assess the efficacy of combined dobutamine and dopamine in CS. Elevation of troponin in CS may identify patients who present late. Arterial lactate is preferable since venous lactate is generally higher than arterial lactate and the 2. A low serum bicarbonate level is a better predictor of day mortality than the highest recorded lactate level.
A low B-type natriuretic peptide BNP level argues against CS in the setting of hypotension; however, an elevated BNP level does not establish the diagnosis, as any form of cardiac ventricular or atrial stress may elevate levels of this peptide. It is recommended to use a pulmonary artery catheter in the diagnosis and management of CS patients, along with rapidly transferring those requiring a higher level of care to an experienced shock center.
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