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    1) The document discusses the management of acute heart failure and cardiogenic shock. Cardiogenic shock is defined as having a systolic blood pressure under 90 mmHg for over 30 minutes, signs of impaired organ perfusion, and a reduced cardiac index. 2) Treatment depends on the clinical profile and includes treating the underlying cause such as through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS). For acute mechanical causes, echocardiography and surgical or percutaneous intervention may be needed. 3) Initial management also involves optimizing preload, contractility and afterload through diuretics, inotropic drugs, vasodil

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    Syok Kardiogenik

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    1) The document discusses the management of acute heart failure and cardiogenic shock. Cardiogenic shock is defined as having a systolic blood pressure under 90 mmHg for over 30 minutes, signs of impaired organ perfusion, and a reduced cardiac index. 2) Treatment depends on the clinical profile and includes treating the underlying cause such as through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS). For acute mechanical causes, echocardiography and surgical or percutaneous intervention may be needed. 3) Initial management also involves optimizing preload, contractility and afterload through diuretics, inotropic drugs, vasodil

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    11 views29 pages

    Managing Shock in AHF

    Uploaded by

    dwiputrahaliim
    1) The document discusses the management of acute heart failure and cardiogenic shock. Cardiogenic shock is defined as having a systolic blood pressure under 90 mmHg for over 30 minutes, signs of impaired organ perfusion, and a reduced cardiac index. 2) Treatment depends on the clinical profile and includes treating the underlying cause such as through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS). For acute mechanical causes, echocardiography and surgical or percutaneous intervention may be needed. 3) Initial management also involves optimizing preload, contractility and afterload through diuretics, inotropic drugs, vasodil

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 29

    Managing Shock in

    Acute Heart Failure

    Andi Mahavira
    Triad kardiovaskular :
    • Irama jantung (Rate)
    • Volume
    • Miokardium (pompa)

     Dasar diagnosis gangguan hemodinamik


    Blood Pressure

    Cardiac
    Cardiac Output
    Output Total
    Total Peripheral
    Peripheral Resistance
    Resistance

    Stroke
    Stroke Volume
    Volume Heart
    Heart Rate
    Rate

    Preload
    Preload Contractility Afterload
    Cardiogenic Shock: Definition
    • Systolic blood pressure <90 mmHg for >30 minutes or
    vasopressors required to achieve ≥ 90 mmHg
    • Pulmonary congestion or pulmonary capillary wedge pressure (PCWP) >18 mmHg
    • Signs of impaired organ perfusion (at least 1)
    – Altered mental status
    – Cold, clammy skin and extremities
    – Oliguria with urine output <30 mL/hour
    – Serum lactate >2.0 mmol/L
    • Reduced Cardiac index (< 1.8 L/min/m2 without support, and 2.0-2.2 L/min/m2
    with support) (optional)
    Thiele H and Zeymer Uwe. The ESC Textbook of Intensive and Acute Cardiovascular Care,2015: 441 – 448
    European Heart Journal (2008) 29, 2388–2442
    European Heart Journal (2012) 33, 1787–1847
    ACS  TREAT UNDERLYING CAUSE:
    CATH  PCI
    CABG
    European Heart Journal (2012) 33, 1787–1847
    Ponikowski et al. Eur Heart J 2016; 37(27): 2129-2200
    Management of patients with acute heart
    failure based on clinical profile
    during an early phase

    Ponikowski et al. Eur Heart J 2016; 37(27): 2129-2200


    Ponikowski et al. Eur Heart J 2016; 37(27): 2129-2200
    Ponikowski et al. Eur Heart J 2016; 37(27): 2129-2200
    2 menit !

    Ponikowski et al. Eur Heart J 2016; 37(27): 2129-2200


    Case

    ► Laki-laki, 54 tahun riwayat PCI 1 tahun yang lalu, datang ke IGD dengan
    keluhan sesak nafas yang makin berat sejak 1 hari yang lalu. 2 hari
    sebelumnya pasien sering mengeluh nyeri dada.
    ► PF : pasien tampak gelisah,
    ► TD 70/40 mmHg HR 108 x/mnt
    ► RR 30 x/mnt , Ronki basah ½ lapang paru
    ► Saturasi 88% (room air)
    ► JVP meningkat
    ► Nadi lemah dan Akral dingin
    • Apa masalah pada pasien ini ?

    • Profil Hemodinamik ?
    Diuretik
    Dry WET Vasodilator

    Warm
    A B

    L C
    • Syok Kardiogenik
    • STEMI akut Killip 4
    Inotropic drugs :
    Cold Dobutamine
    Milrinone
    Levosimendan
    IABP
    Management of patients with acute heart
    failure based on clinical profile during an
    early phase

    Ponikowski et al. Eur Heart J 2016; 37(27): 2129-2200


    ACS

    • Scirica BM and Morrow DA. Braunwald’s Heart Disease, 10th ed, 2015: 1068 –
    1094

    • Ponikowski et al. Eur Heart J 2016; 37(27): 2129-2200

    • Keeley EC,and Hillis LD, N Engl J Med, 2007; 356:47-54


    • Transcutan Pacemaker
    • Medikamentosa

    • Kardioversi
    A. Free wall Rupture
    B. Ventricular septal rupture
    C. Papillary muscle rupture

    • Echocardiography
    • IABP (Bridging)

    • Surgical /
    Percutaneous
    Intervention
    Other Acute
    Mechanical Cause
    • chest trauma or cardiac intervention, or
    • acute native or prosthetic valve incompetence
    secondary to
    • endocarditis,
    • aortic dissection
    • thrombosis and
    • Cardiac tumours

    • Echocardiography
    • Surgical / percutaneous intervention
    Basic Principle of IABP

    • Helium is rapidly pumped into and out of the balloon.


    to support
    When the circulation:
    inflated, this balloon displaces the blood that is in the aorta

    •• Before surgical correction of specific acute mechanical problems


    Sudden inflation moves blood superiorly and inferiorly to the balloon
    (e.g. interventricular septal rupture and acute mitral regurgitation),
    increasing perfusion to the heart and distal organs (brain, kidneys, tissues,
    • severe  DIASTOLIC
    etc.) acute myocarditisAUGMENTATION

    •• inWhen the
    selected balloon
    patients is suddenly
    with deflated,
    acute myocardial the pressure
    ischaemia within the aorta
    or infarction
    drops
    before, during and
    quickly AFTERLOAD
    after REDUCTION
    percutaneous or surgical revascularization.
    Ponikowski et al. Eur Heart J 2016; 37(27): 2129-2200
    Shock /
    Hypotension

    • Thrombolysis,
    S1 Q3 T3 • Catheter-based or
    • Goldhaber SZ. Braunwald’s Heart Disease, 9th ed, 2012: 1679 – 1695 Surgical Embolectomy.
    • Ponikowski et al. Eur Heart J 2016; 37(27): 2129-2200
    Circulation. 2000;102(suppl 1):I-172–I-216 (26).
    Terima Kasih

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