Journal des soins intensifs et critiques Libre accès

Abstrait

Impact of Vascular Aging in Patients Presenting with Hypertension, Coronary Artery Disease or Heart Failure and Cardiogenic Shock

Lawrence J Mulligan, Christopher Potestio, Kenyon Sprankle

Cardiogenic Shock (CS) presents a complex physiological environment for physicians to navigate. The presence of CS is frequently found in patients suffering from Hypertension (HTN), Coronary Artery Disease (CAD) and Heart Failure (HF). Adding to these disease states is the underlying and underappreciated state of Vascular Aging (VA) and sub sequent microvascular dysfunction. Vascular aging includes the loss of aortic compliance and is logically associated with the disease states listed and is quantified using pulse-wave velocity and an increase in the Augmentation Index (AIx).

These disease states are also associated with a loss of microvascular regulation of blood flow. The loss of aortic compliance coupled with microvascular dysfunction presents a complicated setting for the intensive care physician. Restoration of perfusion pressure is the goal, but the presence of vascular aging combined with cardiovascular dis eases impacts the success rate in the CS patient. Understanding how the presence of VA coupled with microvascular dysfunction may add to the complexity of treatment is the focus of this review.