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Signa Vitae

Journal of Anaesthesia, Intensive Care and Emergency Medicine

Acute heart failure and cardiogenic shock


Cardiovascular disease accounts for one quarter of all deaths, and once cancer mortality is excluded, cardiac disease alone accounts for more deaths than all other causes put together. Heart failure (defined as the inability of the heart to pump enough blood to meet the demands of the body) is common, being the primary cause of hospital admission in >1million patients per year in the USA, with 25% readmitted within 1 month, and a 10-20% mortality at 6 months after discharge. In newly diagnosed patients there is a >20% mortality at one year, rising to 50% at two years and >66% at ten years – proving as malignant as many common cancers. The underlying causes include coronary artery disease, hypertension, valve dysfunction, cardiomyopathies (inherited and acquired), congenital heart disease, arrhythmia, toxins (either ‘recreational’ – cocaine and alcohol, or therapeutic – some chemotherapeutic agents), pulmonary embolism and sepsis. Acute heart failure (AHF) may be a new diagnosis in patients with no history of cardiac disease, or occur as a result of acute decompensation in patients with known heart failure. It is the leading cause of hospital admission in people >65 years in the UK. European-wide, approximately 50% of these patients will be readmitted within 12 months, and 30% deceased at the 1-year follow-up.

Key words: cardiogenic shock, heart failure, mechanical circulatory support

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Percutaneous mechanical support in acute coronary syndromes


Despite advances in interventional cardiology, persistently disappointing outcomes in patients with cardiogenic shock complicating myocardial infarction, together with the lack of evidence the that intra-aortic balloon pump improves outcomes in this patient population have led to a re-evaluation of other types of mechanical circulatory support. The increase in extracorporeal membrane oxygenation (ECMO) prompted by the H1N1 pandemic led to an increase in experience in using this technique in critically ill adult patients, and its use is now expanding in both respiratory and cardiac failure. Despite enthusiasm for the technique, high-quality evidence is lacking for its benefit. Nonetheless, ECMO and other types of percutaneous mechanical circulatory support do provide critical care clinicians with new supportive therapies that may prove to benefit patients, both from the high level of support that can be offered, and also minimising the use of potentially toxic inotropic agents.

Key words: cardiogenic shock, heart failure, mechanical circulatory support, extracorporeal membrane oxygenation, ECMO, myocardial infarction, acute coronary syndromes

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