IMPROVING CARDIOGENIC SHOCK OUTCOMES & VENTRICULAR SEPTAL RUPTURE PATIENTS

By 121 News Reporter

Chandigarh 20^th March:-- Cardiovascular disease is the leading cause of mortality and morbidity in the developing nations, with four to five times as many deaths than developed nations. A devastating complication of coronary artery disease is cardiogenic shock, where progressive hypotension and organ failure develop as a consequence of acute myocardial infarction. A multiplicity of factors like diabetes, smoking, unhealthy dietary habits and sedentary lifestylecoupled with delays in transport, leads to patients often presenting to tertiary Centre’s like ours in an advanced stage.

For the last three years, the Department of Cardiology under Dr. Yash Paul Sharma and his cardiac team has been pursuing intensive goal-directed research for the management of patients sustaining acute myocardial infarction complicating cardiogenic shock. There have been significant advances in this sick population of patients. Collected data of 127 patients shows an overall mortality of around 54%. These data are more significant considering the fact that we include a considerably sicker population with more co-morbidities, like older age and multi-organ dysfunction compared to other studies in such patients. Removal of sicker sub-groups such as very old patients, renal disease, etc. will result in mortality levels less than 50%. Prominent among our treatment principles is importance to intensive resuscitation measures, like inotropic support, intra-aortic balloon counter pulsation (even in bedside), GpIIbIIIa inhibitors and early thrombolysis. A disturbing finding is that around 25% of cardiogenic shock patients are young (<50 years). This emphasizes on the importance of modification of the previously mentioned risk factors.

An important achievement has been in the subgroup of patients with ventricular septal rupture.  Published data from the Department include a report of seven patients of post MI-VSR managed at our institution. Six patients underwent IABP insertion with surgical revascularization in the same setting. The mortality was surprisingly low, with only one patient dying. Therefore not all patients require emergency revascularization and closure of defect.We published our results inHeart Asia which is an international cardiovascular journal. Intensive early medical stabilization of acute coronary syndrome with cardiogenic shock, use of IABP for hemodynamic support and delayed revascularization with patch closure of defect is therefore of paramount importance for achieving improved outcomes and we are hopeful of more success in the future.