Carta al Director
Shock cardiogénico y embolia de pulmón
Cardiogenic Shock and Pulmonary Embolism
Carlos Romero Gómez
, Josefa Andrea Aguilar García, María Dolores Martín Escalante
Corresponding author
Servicio de Medicina Interna, Agencia Pública Hospital Costa del Sol, Marbella, Málaga, España
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"afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Agencia Pública Hospital Costa del Sol, Marbella, Málaga, España" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cardiogenic Shock and Pulmonary Embolism" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hemos leído con interés el consenso nacional para el diagnóstico, estratificación de riesgo y tratamiento de los pacientes con tromboembolismo pulmonar (TEP)<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. En la estratificación pronóstica de los pacientes con TEP, basado en su estado hemodinámico, se consideran de alto riesgo a los pacientes que presentan hipotensión (presión arterial sistólica menor de 90<span class="elsevierStyleHsp" style=""></span>mmHg mantenida) o <span class="elsevierStyleItalic">shock</span> cardiogénico. En los pacientes con <span class="elsevierStyleItalic">shock</span> cardiogénico se les recomienda tratamiento con fibrinolítico.</p><p id="par0010" class="elsevierStylePara elsevierViewall">El término <span class="elsevierStyleItalic">shock</span> o choque, es una situación clínica con fallo circulatorio que produce hipoperfusión e hipoxia<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. Una gran contribución a la comprensión de la fisiopatología del <span class="elsevierStyleItalic">shock</span> se la debemos al Dr. Max Harry Weil<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>, que propuso ya a principios de los 70, una clasificación fisiopatológica de los estados de <span class="elsevierStyleItalic">shock</span><a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>. El <span class="elsevierStyleItalic">shock</span> resulta de 4 formas potenciales, no excluyentes: hipovolemia, cardiogénico, obstructivo o distributivo (asociado principalmente a sepsis y anafilaxia). Se considera al <span class="elsevierStyleItalic">shock</span> cardiogénico al que se produce como consecuencia de insuficiencia cardiaca asociado a una disminución del gasto cardiaco. Causas de <span class="elsevierStyleItalic">shock</span> cardiogénico son el infarto agudo de miocardio, estadio final de cardiomiopatías o valvulopatías, miocarditis o arritmias<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>. El <span class="elsevierStyleItalic">shock</span> obstructivo es más infrecuente e incluye a diferentes entidades: embolia pulmonar, taponamiento cardiaco, disección aórtica y neumotórax a tensión. Su mecanismo fundamental es una poscarga aumentada<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. Entiendo que la denominación correcta sería hablar de <span class="elsevierStyleItalic">shock</span> obstructivo o simplemente <span class="elsevierStyleItalic">shock</span>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">No obstante, la presentación clínica de la embolia pulmonar puede ser similar al <span class="elsevierStyleItalic">shock</span> cardiogénico, siendo considerado por algunos autores como una forma de <span class="elsevierStyleItalic">shock</span> cardiogénico. En las 2 mismas guías sobre tratamiento de la enfermedad tromboembólica referenciadas<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>, la <span class="elsevierStyleItalic">American College of Chest Physicians</span> y el <span class="elsevierStyleItalic">National Institute for Health and Clinical Excellence</span>, tampoco se ponen de acuerdo en la denominación. Así, en la primera solo se hace referencia al término <span class="elsevierStyleItalic">shock</span>, mientras que en la segunda se denomina <span class="elsevierStyleItalic">shock</span> cardiogénico. Independientemente de su denominación, consideramos que este documento es de indudable valor y ayuda para el manejo de nuestros pacientes.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consenso nacional sobre el diagnóstico, estratificación de riesgo y tratamiento de los pacientes con tromboembolia pulmonar" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Uresandi" 1 => "M. Monreal" 2 => "F. García-Bragado" 3 => "P. Domenech" 4 => "R. Lecumberri" 5 => "P. Escribano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2013.07.008" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "534" "paginaFinal" => "547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24041726" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Circulatory shock" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.L. Vicent" 1 => "D. de Backer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra1208943" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2013" "volumen" => "369" "paginaInicial" => "1726" "paginaFinal" => "1734" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24171518" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Circulatory shock an update: A tribute to Professor Max Harry Weil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Vincent" 1 => "C. Ince" 2 => "J. Bakker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc11510" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2012" "volumen" => "16" "paginaInicial" => "239" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23171699" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proposed reclassification of shock states with special reference to distributive defects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.H. Weil" 1 => "H. Shubin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Adv Exp Med Biol" "fecha" => "1971" "volumen" => "23" "paginaInicial" => "13" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5164840" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiogenic shock: Currents concepts and improving outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.R. Reynolds" 1 => "J.S. Hochman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.106.613596" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2008" "volumen" => "117" "paginaInicial" => "686" "paginaFinal" => "697" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18250279" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005100000003/v2_201502240247/S0300289614001306/v2_201502240247/es/main.assets" "Apartado" => array:4 [ "identificador" => "9222" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director / Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005100000003/v2_201502240247/S0300289614001306/v2_201502240247/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614001306?idApp=UINPBA00003Z" ]
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