Catecholamine therapy in cardiogenic shock: helpful, useless or dangerous?

Deutsche medizinische Wochenschrift
H SchwertzM Buerke

Abstract

Cardiogenic shock is characterized by inadequate organ and tissue perfusion, due to cardiac dysfunction, predominantly following acute myocardial infarction. Mortality rates for patients with cardiogenic shock remain high, ranging from 50-70 % despite effective therapy. Rapid diagnostics, aggressive therapeutic approach (invasive or surgical revascularisation) and pharmacological support are currently used to improve the clinical outcome and survival. In the first line commonly sympathomimetics like dopamine, dobutamine, epinephrine and norepinephrine are used for the pharmacological treatment. They have a high affinity for alpha- and beta adrenergic receptors, leading to a positive inotropic cardiac function, an increase in heart rate, oxygen enhanced demand, and an increase in vasoconstriction. However, there are also some disadvantages in the use of sympathomimetics in patients with cardiogenic shock. Clearly, metabolic acidosis due to the increased oxygen demand can be observed. Vasoconstriction induced by sympathomimetics can lead to perfusion mismatch or even deficit within the microcirculation. Additionally, in some studies which give evidence that the use of sympathomimetics can directly lead to enhanced systemic inflam...Continue Reading

Citations

Oct 6, 2009·Critical Care : the Official Journal of the Critical Care Forum·Christian TorgersenMartin W Dünser
Nov 24, 2007·Der Internist·M BuerkeK Werdan
Mar 17, 2007·Scandinavian Cardiovascular Journal : SCJ·B TraboldD Fröhlich
Mar 26, 2015·Medizinische Klinik, Intensivmedizin und Notfallmedizin·R RiessenM Haap
Jun 10, 2015·Der Internist·H LemmM Buerke
Aug 4, 2018·Medizinische Klinik, Intensivmedizin und Notfallmedizin·Uwe Janssens
Apr 20, 2018·Medizinische Klinik, Intensivmedizin und Notfallmedizin·D HusterH Ebelt

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