Gå direkt till huvudinnehållet

Kardiogen chock

Senast reviderad:
Sakkunnig:
Definition:
Akut hjärtsviktssyndrom med hypotension och betydlig reduktion av hjärtats minutvolym och reducerad vävnadsperfusion. Orsakas oftast av hjärtinfarkt.
Förekomst:
Förekommer hos 5–15 % av alla akuta hjärinfarkter.
Symtom:
Eventuellt symtom på hjärtinfarkt. Svettig och kall hud, dyspné, eventuell kognitiv påverkan/sänkt medvetandegrad.
Fynd:
Systoliskt blodtryck <90 mmHg i mer än 30 minuter, eller att vasoaktiva läkemedel behövs för att hålla blodtryck ≥90 mm, lungstockning (stas), ofta takykardi.
Behandling:
Akutmedicinskt tillstånd som kräver behandling med nitroglycerin, morfin, akut PCI vid hjärtinfarkt och intensivbehandling på sjukhus.
  1. Moskovitz JB, Levy ZD, Slesinger TL, et al. Cardiogenic Shock. Emerg Med Clin North Am. 2015 Aug;33(3):645-52. PubMed  
  2. Thiele H, Ohman EM, Desch S, et al. Management of cardiogenic shock. Eur Heart J 2015; 36: 1223-30. pmid:25732762 PubMed  
  3. Hochman JS, Buller CE, Sleeper LA et al. Cardiogenic shock complicating acute myocardial infarction - etiologies, management and outcome: a report from the SHOCK Trial Registry. J Am Coll Cardiol 2000; 36: 1063-70. PubMed  
  4. van Diepen S, Katz JN, Albert NM, et al. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation 2017; 136: e232-2268. pmid:28923988 PubMed  
  5. Antman EM, Anbe DT, Armstrong PW et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2004; 44: E1-E211.
  6. Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA 2006; 295: 2511-5. Journal of the American Medical Association  
  7. Aissaoui N, Puymirat E, Tabone X, et al. Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French Nationwide Registries. Eur Heart J 2012; 33: 2535-43. pmid:22927559 PubMed  
  8. Berger PB, Holmes DR Jr, Stebbins AL, Bates ER, Califf RM, Topol EJ. Impact of an aggressive invasive catheterization and revascularization strategy on mortality in patients with cardiogenic shock in the global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries (GUSTO-I) trial. Circulation 1997;96: 122-7 Circulation  
  9. Dauerman HL, Goldberg RJ, White K et al. Revascularization, stenting, and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. Am J Cardiol 2002; 90: 838-42. PubMed  
  10. Schumann J, Henrich EC, Strobl H, et al. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database of Systematic Reviews 2018; 1: Art. No.: CD009669.. doi:10.1002/14651858.CD009669.pub3 DOI  
  11. Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock. Final 12-month results of the randomised IntraAortic Balloon Pump in cardiogenic shock II (IABP-SHOCK II) Trial. Lancet 2013;382:1638–1645. PMID:24011548. PubMed  
  12. Thiele H, Zeymer U, Neumann F-J, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367: 1287-96. PMID:22920912. PubMed  
  13. Hazinski MF Nolan JP Billi JE et al. Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010;122: 250–75. PMID: 20956249 PubMed  
  14. Cheng R, Hachamovitch R, Kittleson M, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1,866 adult patients. Ann Thorac Surg 2014;97:610–616. PMID: 24210621 PubMed  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

  • Karl Swedberg, senior professor och överläkare, Enheten för akut och kardiovaskulär medicin, Institutionen för medicin, Sahlgrenska Akademin, Göteborg
  • Bjørnar Grenne, specialistläkare och med. dr, Sørlandet sykehus, Arendal
  • Terje Johannessen, professor i allmänmedicin, Institutt for samfunnsmedisinske fag, Norges teknisk-naturvitenskapelige universitet, Trondheim