Cardiogenic shock secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Syed Musadiq Ali M.B.B.S.[3]
Overview
Secondary prevention includes early detection and halting the progression of established but asymptomatic disease. For CAD, this includes taking measures to prevent cardiovascular symptoms (e.g., dyspnea), damage (e.g., ventricular dysfunction), and events (e.g., acute coronary syndromes). However, once such symptoms, damage, or events occur, it is too late for secondary prevention.
Secondary prevention
Attending to the definition of secondary prevention, namely the methods or techniques used in order to avoid the development of symptoms of an already existent disease, and considering the fact that left ventricular failure following MI is the most common cause of cardiogenic shock, these patients should undergo secondary prevention of myocardial infarction. This is a crucial part of the management of STEMI patients, regardless of their gender.[1][2][3][4] Since atherosclerotic disease is commonly found in multiple vessels in STEMI patients, these should be evaluated for possible signs or symptoms of peripheral vascular or cerebrovascular disease.[1] As secondary prevention, these patients have the following indications:[1]
- Education of patient and family members before discharge - particularly about the importance of lifestyle changes and adherence to the selected treatment.
- Exercise/physical activity - with an optimal target of daily physical activity and a minimum of 30 minutes/day, 3 to 4 times per week.
- Lipid management - if TG <200 mg/dL, then goal of LDL-C <<100 mg/dL; if TG ≥200 mg/dL, then goal of non-HDL-C << 130 mg/dL
- Weight management - goal BMI of 18.5-24.9 kg/m2 and Waist Perimeter: women - <35 inches, men - <40 inches.
- Blood pressure control - goal <140/90 mm Hg or <130/80 mm Hg if concomitant diabetes or kidney disease.
- Control of diabetes - goal of HbA1c < 7%.
- Smoking cessation - goal of complete cessation.
- Antiplatelet therapy
- RAAS inhibition
- Beta-blockage
- Hormone therapy in women
- Warfarin therapy
- Antioxidant intake
References
- ↑ 1.0 1.1 1.2 Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M; et al. (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)". Circulation. 110 (5): 588–636. doi:10.1161/01.CIR.0000134791.68010.FA. PMID 15289388.
- ↑ Smith, S. C.; Blair, S. N.; Bonow, R. O.; Brass, L. M.; Cerqueira, M. D.; Dracup, K.; Fuster, V.; Gotto, A.; Grundy, S. M.; Miller, N. H.; Jacobs, A.; Jones, D.; Krauss, R. M.; Mosca, L.; Ockene, I.; Pasternak, R. C.; Pearson, T.; Pfeffer, M. A.; Starke, R. D.; Taubert, K. A. (2001). "AHA/ACC Guidelines for Preventing Heart Attack and Death in Patients With Atherosclerotic Cardiovascular Disease: 2001 Update: A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology". Circulation. 104 (13): 1577–1579. doi:10.1161/hc3801.097475. ISSN 0009-7322.
- ↑ Mosca, L. (2004). "Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women". Circulation. 109 (5): 672–693. doi:10.1161/01.CIR.0000114834.85476.81. ISSN 0009-7322.
- ↑ Dalal H, Evans PH, Campbell JL (2004). "Recent developments in secondary prevention and cardiac rehabilitation after acute myocardial infarction". BMJ. 328 (7441): 693–7. doi:10.1136/bmj.328.7441.693. PMC 381231. PMID 15031243.