MINISTRY OF EDUCATION & TRAINING MINISTRY OF DEFENCE
108 INSTITUTE OF CL INICAL MEDICAL AND
PHAR MACE UTICAL SCIENCES
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NGUYEN MANH DUNG
STUDY ON THE HEMODYNAMIC EFFECT OF INTRA-
AORTIC BALLOON PUMP COUNTERPULSATION
THERAPY IN PATIENTS WITH CARDIOGENIC SHOCK
AFTER MYOCARDIAL INFARCTION
Specialty: Anesthesia and Critical Care
Code: 62.72.01.22
ABSTRACT OF MEDICAL PHD THESIS
Hanoi – 2019
THE THESIS WAS DONE IN: 108 INSTITUTE OF CLINICAL
MEDICAL AND PHARMACEUTICAL SCIENCES
Supervisor:
1. Assoc. Prof. PhD. Tran Duy Anh
2. Assoc. Prof. PhD. Le Thi Viet Hoa
Reviewer:
1.
2.
3.
This thesis will be presented at Institute Council at: 108 Institute of
Clinical Medical and Pharmaceutical Sciences
Day Month Year
The thesis can be found at:
1. National Library of Vietnam
2. Library of 108 Institute of Clinical Medical and
Pharmaceutical Sciences
1
INTRODUCTION
Cardiogenic shock (CS) is a condition of reduced tissue perfusion,
due to impairment of the pumping function of ventricles under normal
circulation volume. In patients with myocardial infarction, cardiogenic
shock was the highest mortality rate, the previous mortality rate was 80%,
thanks to improvements in emergency and treatment, mortality rates were
reduced to 40-50%.
Active treatment to restore, maintain hemodynamic stability,
ensure optimal blood oxidation and coronary revascularization was the
main treatment for patients with cardiogenic shock after myocardial
infarction. The emergence of mechanical support facilities such as intra-
aortic balloon pump counterpulsation (IABP), left ventricular support,
ECMO... contribute to increasing the quality of cardiogenic shock
treatment.
IABP is a device that supports mechanical circulation, is placed
through the femoral artery by Seldinger technique, the balloon is inflated
in the diastole (increased coronary artery perfusion, cerebral vessels), is
rapidly flushed in the systole (reduced heart activity, reduced the need for
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2
cardiac muscles and increased cardiac output). In 1968, IABP
technique was first used for patients with cardiogenic shock after
myocardial infarction, with 70,000 - 100,000 cases in the United States
every year.
In Vietnam, IABP has been used in some hospitals, such as: Ho Chi
Minh City Heart hospital (2005), 108 Military Central Hospital (2009), Hanoi
Heart hospital (2012)... has brought good effects on patients with severe heart
failure after open heart surgery, cardiogenic shock.
In order to assess the effectiveness and safety of intra-aortic
balloon pump counterpulsation (IABP) in hemodynamic support to
patients with cardiogenic shock due to myocardial infarction, we
conducted the study"Study on the hemodynamic effect of intra-aortic
balloon pump counterpulsation (IABP) therapy in patients with
cardiogenic shock after myocardial infarction”with two objectives:
1. Efficacy of intra-aortic balloon pump counterpulsation (IABP) in
hemodynamic support to patients with cardiogenic shock after
myocardial infarction
2. Remarks on the efficacy of treatment and complication of intra-aortic
balloon pump counterpulsation (IABP) in the treatment of cardiogenic
shock after myocardial infarction
2
Chapter 1
OVERVIEW
1. Cardiogenic shock after myocardial infarction
1.1. Definition and diagnosis of cardiogenic shock after
myocardial infarction
* Definition of cardiogenic shock
Cardiogenic shock is defined as tissue hypoperfusion resulting from
ventricular pump failure in the presence of adequate intravascular
volume.
* Diagnosis of cardiogenic:
- SBP less than 90 mm Hg for greater than 30 minutes or use of
vasopressors to achieve those levels.Evidence of pulmonary edema
or elevated left ventricle (LV) filling pressures (LV end diastolic
pressure or PCWP).
- Evidence of organ hypoperfusion including at least one of the
following: (a) change in mental status; (b) cold, clammy skin; (c)
oliguria; (d) increased serum lactate.
1.2. Causes and pathogenesis of cardiogenic shock
1.2.1. Causes of cardiogenic shock
Cardiogenic shock may occur acute in patients without a previous
history of heart disease or progressive disease progression in patients
with persistent chronic heart failure, most commonly acute coronary
syndrome: 80%. Although advances in treatment and
revascularization, cardiogenic shock remains the most dangerous
complication of myocardial infarction with a mortality rate of about
38% to 65%. Cardiogenic shock after myocardial infarction is most
commonly caused by ischemic heart muscle dysfunction, infarction
or mechanical complications.
1.2.2. Pathogenesis
Acute myocardial ischemia due to coronary arteries reduces the
function of myocardial contractility and the ejection capacity of the
ventricles and increasing the final filling pressure. Decreased systolic
function leads to reduced cardiac output, arterial hypotension,
reduced perfusion and reduced systemic oxygen supply. Systemic
inflammatory response causes systemic vasodilation, inhibits
myocardial contraction causing severe progressive shock.
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Figure 1.1. Pathogenesis of cardiogenic shock after myocardial infarction
1.2.3. Hemodynamics of cardiogenic shock after myocardial
infarction
Pathophysiology of cardiogenic shock, illustrated by pressure-volume
loop. ESPVR goes down and to the right, there is a sudden loss of
contraction, severe decrease in blood pressure, volume of squeeze and
heart supply. Neural-activated receptors automatically reach the heart,
vascular structures, and activate the adrenal gland to release epinephrine.
These factors increase heart rate, increase heart contraction and cause
systemic vasoconstriction, increase SVR and cause vasoconstriction -
making changes to the left side of the P-V loop(Figure 1.3).
Figure 1.3. The pathophysiology of CS illustrated by use of PV loops