Cardiogenic shock: can the well-forgotten old become the new?

Abstract

Cardiogenic shock (CS) is considered to be the most severe variant of acute heart failure. It occurs against the background of myocardial infarction or non-coronary myocardial disease with the loss of 40-50% contractile ability by the left ventricular mass and acute heart overload of another genesis. The marked decrease of blood pressure is accompanied by generalized impairment of microcirculation in all organs. The acting recommendations for emergency assistance suggest to recover blood perfusion pressure in ischemic tissues by inotropic drugs vasopressors, crystalloids that eliminate hypovolemia. However, the recovery of hemodynamic parameters using these medicines is accompanied by increased load on the myocardium and causes only a slight temporary increase of blood pressure. Death rapidly occurs in almost 100% of cases because offast heart energy depletion There is no doubt that stable recovery of hemodynamic in CS is not possible without sustainable recovery of myocardial contractility. The effective discharge of myocardium by drugs should not be accompanied by deterioration of blood supply to peripheral organs. Taking into account the literature data and pharmacological properties of different groups of drugs, there is every reason to believe that nitroglycerin may be the drug of choice for the treatment of cardiogenic shock. It reduces myocardium preload without impairment of microcirculation in the peripheral organs. This conclusion is preliminary and requires verification in randomized trials.