Abstract
Cardiogenic shock is the leading cause of death in patients with acute myocardial infarction, with high hospital mortality rates ∼80 %. The incidence of cardiogenic shock among myocardial infarction patients is approximately 7 %. Cardiogenic shock patients are found that pre-existing diabetes is associated with an increased risk of cardiogenic shock and it worsens outcomes, with a longer hospital stay. Cardiogenic shock develops approximately twice as often among diabetics as among nondiabetic patients with acute myocardial infarction. Diabetes mellitus and left bundle branch block are predictors of cardiogenic shock complicating acute myocardial infarction. Except for bad prognosis, left bundle branch block can be a marker of a slowly progressing, degenerative, ischemic or non-ischemic cardiac disease, affecting not only the muscle but also the heart conduction system. Immediate diagnosis and management are required. In this article, a clinical case of acute posterior myocardial infarction complicated by complete left bundle branch block and cardiogenic shock in the patient with concomitant diabetes mellitus type 2 is demonstrated. This article emphasizes the priority of referring patients with left bundle branch block to primary percutaneous coronary intervention, usage of more specific ECG criteria for acute coronary syndrome, the role of myocardial infarction biomarker including sensitive assays for cardiac troponins, and bedside echocardiography which may improve diagnostic accuracy and result in timely intervention in such patients. This article also underlines the role of mechanical circulatory support, urgent reperfusion therapy, and strict control of glycemia in the acute phase of myocardial infarction which may contribute to clinical stability of patients with diabetes mellitus and myocardial infarction complicated by cardiogenic shock.
Highlights
In the large study with 72,765 population, several important risk factors such as cardiogenic shock patients were found that preprevious MI, infarct size, and location have been existing diabetes was associated with an increased identified as predictors of cardiogenic shock, but risk of cardiogenic shock (5.8 % vs 5.2 %; adjusted the death from cardiogenic shock complicating MI odds ratio [aOR] 1.14) and it worsens outcomes is a main contributor to the in-hospital mortality of
Managing of hyperglycemia in acute phase of MI with life-important necessary hypoglycemia avoidance may help in maintaining clinical stability of DM patients with MI complicated by cardiogenic shock
Харьковского национального университета имениВ. Н. Каразина, пл. Свободы, 6 Харьков, Украина, 61108. Богун Наталия Юрьевна, асистент кафедры пропедевтики внутренней медицины и физической реабилитации Октябрева Ирина Ивановна, асистент кафедры пропедевтики внутренней медицины и физической реабилитации Conflicts of interest: author has no conflict of interest to declare. Конфлікт інтересів: відсутній. Конфликт интересов: отсутствует
Summary
Diabetes mellitus and left bundle branch block are predictors of cardiogenic shock complicating acute myocardial infarction. A clinical case of acute posterior myocardial infarction complicated by complete left bundle branch block and cardiogenic shock in the patient with concomitant diabetes mellitus type 2 is demonstrated. This article emphasizes the priority of referring patients with left bundle branch block to primary percutaneous coronary intervention, usage of more specific ECG criteria for acute coronary syndrome, the role of myocardial infarction biomarker including sensitive assays for cardiac troponins, and bedside echocardiography which may improve diagnostic accuracy and result in timely intervention in such patients. This article underlines the role of mechanical circulatory support, urgent reperfusion therapy, and strict control of glycemia in the acute phase of myocardial infarction which may contribute to clinical stability of patients with diabetes mellitus and myocardial infarction complicated by cardiogenic shock
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