Episode 170. New Treatment Modalities for Cardiogenic Shock with Dr James Sapontis (Part 1)
One in five people will develop heart failure in their lifetime. Half will have preserved ejection fraction- HFpEF, which is becoming increasingly prevalent, the other half have heart failure with reduced ejection fraction- so-called HFrEF.
Separate to these two entities an extreme form of heart failure is cardiogenic shock. This most commonly occurs after acute myocardial infarction (AMI) and complicates AMI’s in 5-10% of cases. Cardiogenic shock is a clinical syndrome characterised by decreased cardiac output resulting in end-organ hypoperfusion and tissue ischemia. Patients presenting with ST-elevation myocardial infarction (STEMI) are 2-fold more likely to present with cardiogenic shock than those presenting with a non-STEMI. Cardiogenic shock carries a poor prognosis and is the leading cause of death in patients with acute myocardial infarction. About 80% of patients with cardiogenic shock die despite optimal treatment, usually from complications including dysrhythmias, cardiac arrest, renal failure, ventricular aneurysm, stroke and thromboembolism.
Treatment modalities include medical resuscitation and pharmacologic management, primary percutaneous coronary intervention, urgent coronary artery bypass grafting and artificial circulatory support, drawing upon intra-aortic balloon pumps and extracorporeal membrane oxygenation (ECMO). Additionally, there are non-intra-aortic balloon pump percutaneous mechanical devices as well as cardiac transplantation to consider.
These treatments have reduced in hospital mortality yet, cardiogenic shock patients who survive to reach hospital discharge still have a higher rate of mortality post-discharge than uncomplicated AMI patients.
Some exciting new developments are afoot however with the recent introduction into clinical practice in Australia of the micro axial pump device. I was curious to learn more about this subject and new approach to management and was privileged to have this conversation on the subject with expert cardiologist Dr James Sapontis. James has been involved with some of the steering committees related to cardiogenic shock management and works actively as an interventionalist at many sites in Melbourne including St John of God Berwick and Victorian Heart Hospital. Please welcome James to the podcast.
References:
Dr James's Sapontis : www.jamessapontis.com