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Dtsch Med Wochenschr. 2013 Mar;138(12):576-80. doi: 10.1055/s-0032-1332911. Epub 2013 Mar 12.

["Catecholamine refractory" cardiogenic shock? "Bridging-to-recovery" by implantation of a percutaneous cardiac assist device].

[Article in German]

Author information

1
Klinik für Innere Medizin/ Kardiologie, Herzzentrum Leipzig GmbH der Universität Leipzig. johannes_wilde@web.de

Abstract

HISTORY AND ADMISSION FINDINGS:

A 27-year-old man presented with acute dyspnea and a previous respiratory tract infection with progressive dyspnoea and chest pain over 2 weeks. Clinical findings revealed severe cardiac failure with development of cardiogenic shock and need for adrenergic drug therapy for circulatory support.

INVESTIGATIONS:

The electrocardiogram showed a sinus tachycardia with unspecific T-wave-inversions, the echocardiogram revealed a dilated left ventricle and severely reduced systolic LV-function. An acute coronary syndrome could be excluded by coronary angiogram.

TREATMENT AND COURSE:

A myocardial biopsy was taken to exclude giant cell myocarditis. The immediate initiation of a mechanical circulatory support by an Extracorporal Membrane Oxygenator (ECMO) facilitated rapid hemodynamic stabilization and recovery of organ function.

CONCLUSIONS:

A drug-only circulatory support very often does not enable stabilization of a patient in progressive cardiogenic shock and cannot prevent multiorgan dysfunction. Therefore implantation of an assist device facilitates a "bridging-to-recovery" or a "bridging-to transplant" concept in critically ill patients presenting with cardiogenic shock. The bridging also allows for reviewing etiology and evaluation of further treatment options. In case of recovery continuous care in a specialized Heart Failure Clinic can help to maintain the clinical status and offer frequent reevaluation of cardiac status and therapeutic concepts.

PMID:
23483417
DOI:
10.1055/s-0032-1332911
[Indexed for MEDLINE]
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