Medikamentöse Therapie des infarktbedingten kardiogenen Schocks

Der infarktbedingte kardiogene Schock ist zwar relativ selten, jedoch das prognostisch schwerwiegendste Syndrom in der Intensivmedizin. Welche Anzeichen gibt es? Welche Zielparameter helfen bei der Beurteilung und Therapieplanung? Welche Medikamente beeinflussen welche Zielparameter? Was ist besonders bei einem rechtsventrikulären Infarkt zu beachten? Wie gestaltet sich die übrige medikamentöse Therapie? Dieser Beitrag gibt Antwort auf diese Fragen.

Abstract

Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is a comparably seldom but fatal entity. The definition of cardiogenic shock – unlike e. g. septic shock – is not uniform. Immediate revascularization is central to the patientʼs prognosis in AMI-CS. Patients who continue to meet the criteria of shock despite revascularization should be hemodynamically phenotyped to allow guidance of personalized subsequent therapy. Antiplatelet medication is the cornerstone for maintaining myocardial (re)perfusion. In hypotension, norepinephrine should be used as the first-line vasopressor, depending on afterload and after compensation for possible hypovolemia. Dobutamine is recommended to increase inotropy, possibly augmented or substituted by calcium sensitizers such as levosimendan. PDE-III (phosphodiesterase enzyme type III)-inhibitors should be used with restraint in myocardial infarction. Dopamine is no longer recommended in Europe. A sasodilator may be an option in highly selected patients with AMI-CS. This review will provide a detailed updated overview on pharmacological treatment modalities and indications in individual patients.

Schlüsselwörter

kardiogener Schock - Myokardinfarkt - Schock - Inotropika

Key words

cardiogenic shock - myocardial infarction - shock - inotropics

Publication History

Article published online:
07 September 2022

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