Shock ostruttivo extra-cardiaco
Definizione
Lo shock ostruttivo extra-cardiaco è causato da un ostacolo all’ efflusso di sangue dal ventricolo destro e/o sinistro con conseguente riduzione della perfusione sistemica, ipotensione e shock. 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 che sincope, una permanente grave riduzione della gittata cardiaca.
- Pneumotorace a 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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