sốc tim sau nhồi máu cơ tim cấp

Sốc  %m  sau  nhồi  máu  cơ  %m  cấp   PGS.TS  Hoàng  Anh  Tiến   CARDIOGENIC SHOCK: DEFINITION       Clinical condi%on defined as the inability of the heart to deliver an adequate   amount of blood to the %ssues to meet res%ng metabolic demands as a result of   impairment of its pumping func%on          DIAGNOSTIC CRITERIA   Clinical criteria   Hemodynamic criteria   •Systemic hypotension         •Clinical signs of hypoperfusion   -­‐ Cool, clammy, and mo[led skin, reduced capillary refill, oliguria, altered mental state       •Persistent a]er correc%on of non-­‐myocardial   factors contribu%ng to poor %ssue   perfusion/myocardial dysfunc%on        i.e    hypovolemia, rhythm disturbances,   •         •                     •   SBP 8 μg/kg/min     0,05 μg/kg/min %trate to   effect    Pascal V, Zeymer U Cardiogenic Shock ACCA Clnical Decision-­‐making Toolkit   CARDIOGENIC SHOCK: EATMENT  TR  Me chanical circulatory support  Intra-aortic balloon pump                                     TandemHeart percutaneous LVAD  Impella LP2.5 axial flow LVAD                                     Extracorporeal membrane oxygenation      (ECMO)      Cove ME Critical Care 2010;14:235-46 CARDIOGENIC SHOCK: TREATMENT AHA Scientific Statement Recommendations for the Use of Mechanical Circulatory Support: Device Strategies and Patient Selection: Peura J et al Circulation 2012;126:2648-2667 CARDIOGENIC SHOCK: TREATMENT      AHA Scientific Statement Recommendations for the Use of  Mechanical Circulatory Support: Device Strategies and Patient Selection: A Urgent nondurable MCS is reasonable in hemodynamically compromised HF patients with endorgan dysfunction and/or relative contraindications to heart transplantation/durable MCS that are expected to improve with time and restoration of an improved hemodynamic profile (Class IIa; Level of Evidence C)      B These patients should be referred to a center with expertise in the management of durable MCS and patients with advanced HF (Class I; Level of Evidence C)                                      Peura J et al Circulation 2012;126:2648-2667 CARDIOGENIC SHOCK: DIAGNOSTIC AND TREATMENT CONCLUSIONS •Diagnosis of CS (What) can be done without excessive difficulty using clinical and hemodynamic criteria •Identification of the main causal mechanism (Why) is key to guide therapy •Reperfusion / revascularization in ACS-related cardiogenic shock •Steroids in giant cell myocarditis •Repair of valve disease, mechanical complications, tamponade, arrhythmias… •Circulatory support is needed in a majority of patients Pascal V, Zeymer U Cardiogenoc Shock ACCA Clnical Decison-making Toolkt Taùi thoâng ÑMV bò taéc Thang  điểm  CADILLAC     Yếu tố nguy   Điểm   Phân suất tống máu tâm thu thất trái