SALUTE

Shock ostruttivo extra-cardiaco

Table of Contents

 



Cuore, Medico, Salute, Cardiologia, Medicina, Ospedale

Definizione

Loshock ostruttivo extra-cardiacoè causato da un ostacolo all’ efflusso di sangue dal ventricolo destro e/o sinistro con conseguente riduzione della perfusione sistemica, ipotensione eshock.  Si tratta di una situazione in cui esiste un ostacolo alla circolazione del sangue nell’albero arterioso, mentre la funzione del miocardio stesso non è compromessa.

  • Tamponamento pericardico: la presenza di abbondante liquido nella cavità pericardica impedisce la normale attività cardiaca, per impossibilità del miocardio di distendersi durante la diastole.
  • Embolia polmonare:l’occlusione di un ramo principale delle arterie polmonari comporta il blocco della circolazione in una porzione considerevole dell’albero arterioso.
  • Trombo a palla, mixoma:qualora un trombo a palla o un mixoma occluda soltanto parzialmente ma costantemente, l’ostio valvolare atrioventricolare si avrà, invece chesincope, una permanente grave riduzione della gittata cardiaca.
  • Pneumotoracea valvola: in questa forma di pneumotorace si ha accumulo di aria nella cavità pleurica a ogni atto inspiratorio, che può aggiungere a provocare una compressione del cuore e dei grossi vasi, con conseguente ostacolo all’efflusso di sangue.

Sintomi

Dal punto di vista clinico, i segni e i sintomi sono quelli tipici dello shock, cui possono sovrapporsi quelli tipici della patologia che è responsabile dello shock ostruttivo extra-cardiaco.



 

Diagnosi

Gli esami più comunemente utilizzati per lo shock ostruttivo extra-cardiaco per la diagnosi differenziale sono:

  • Ecocardiografia
  • Cateterismo cardiaco
  • Ecografia addominale
  • Esami di laboratorio per escludere emorragie ed alterazioni della coagulazione.



Terapia

La terapia dipende dalla patologia di base.

  • Pericardiocentesi in corso di tamponamento cardiaco.
  • Anticoagulante e fibrinolitici in corso di embolia polmonare.
  • Drenaggio toracico nello pneumotorace iperteso.
  • Chirurgia d’urgenza in caso di dissezione aortica.
  • Intervento chirurgico in presenza di un mixoma atriale.

 

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