How cardiogenic shock in NSTEMI is different from STEMI?

Cardiogenic shock (CS)is the most feared event following STEMI. The incidence is up to 5 to 10% with a mortality rate of around 50-60%. Still, we are finding it hard to bring this down below 50 % .There is one less addressed issue in ACS literature. We tend to perceive CS as an exclusive complication of STEMI. The fact is that NSTEMI can also result in CS is less recognized. The incidence is half of that of STEMI, i.e., 2.5-5%. Mechanism of CS in NSTEMI One may ask, how can CS occur in NSTEMI with partial occlusion with a non trans-mural MI. ACS pathophysiology is not that simple. Ischemic LV dysfunction (Global stunning) without necrosis is equally sinister. This is what happens in some high risk sub sets of NSTEMI. How is CS in NSTEMI different ? 1.Global ST depression (AVR.V1 might show little elevation with considerable overlap of left main STEMI vs NSTEMI ) 2.Onset of NSTEMI-CS occurs late (48-72 hrs) 3.Severe multivessel disease is more common (It is likely ,presence fold STEMI , is an important factor that is likely to precipitate CS when a new NSTEMI occurs. 4.Echo is likely to show more of a Global hypokinesia rather than specific coronary territory 5.Mechanical complication, though less common in NSTEMI , Ischemic MR especially with LCX- NSTEMI can be problematic and much commoner than we think. 6. A subset of NSTEMI precipitated by acute severe HT and flash pulmonary edema has excellent prognosis if BP is reduced promptly....
Source: Dr.S.Venkatesan MD - Category: Cardiology Authors: Tags: acute coronary syndrome Uncategorized acc aha esc guidlines on stemi shock cardiogenic shock cardiogenic shock in stemi vs nstemi cs in stemi vc nstemi grace registry how is cardiogenic shock in nstemi different from stemi ? iglobal lv stu Source Type: blogs