Kardiogener Schock – Pharmakologische und mechanische Maßnahmen in der Akutphase

Der kardiogene Schock ist in mehr als 3/4 der Fälle durch einen akuten Myokardinfarkt bedingt. Mit einer Latenz von bis zu 12 Stunden tritt der Schock nach akutem Gefäßverschluss meist erst nach Aufnahme in die Klinik auf. Die Mortalität liegt bei 50–70 % und kann durch eine rasche Diagnosestellung, die sofortige Revaskularisation des Infarktgefäßes und eine effektive hämodynamische Stabilisierung gesenkt werden. Pharmaka und mechanische Kreislaufunterstützungssysteme können zur Aufrechterhaltung eines ausreichenden Organperfusionsdruckes eingesetzt werden, um ein Multiorgandysfunktionssyndrom, welches prognoselimitierend ist, zu vermeiden. Entsprechend den aktuellen Leitlinien sollten im kardiogenen Schock Dobutamin und Noradrenalin bevorzugt werden.

Cardiogenic shock is caused in more than 3/4 of all cases by an acute myocardial infarction. Clinical manifestation of shock presents typically with a delay of up to 12 hours after acute coronary occlusion. Mortality rates in cardiogenic shock range between 50 % and 70 %. Therapeutic options include fastest possible coronary revascularization and effective hemodynamic stabilization. Pharmacotherapy and mechanical circulatory support is recommended for maintenance of sufficient organ perfusion pressure, thus preventing prognosis limiting multi-organ-dysfunction. Dobutamin and nor-epinephrine should be preferred for hemodynamic stabilization according to current guidelines.

Key words

Cardiogenic shock - acute myocardial infarction - percuteneous coronary intervention - multiorgan failure - catecholamine - mechanical circulatory assist devices

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