Treatment of cardiogenic shock with the Ca2+ sensitizer levosimendan

Background: First-line therapy of acute heart failure consists of intravenous diuretics and vasodilators. If this regimen fails, patients are usually treated with positively inotropic drugs like the beta-receptor antagonist dobutamine or inhibitors of the phosphodiesterase enzyme (milrinone, enoximone). Although these drugs result in an improvement of the acute hemodynamic situation, they have no positive influence on survival in the long run. Case Report: A young male patient with a cardiogenic shock was transferred to the authors' clinic for coronary angiography, after he had presented to another hospital with acute myocardial infarction. The angiography revealed a subtotal stenosis of the left anterior descending artery. Even after successful angioplasty and implantation of an intraaortic balloon pump as well as treatment with dobutamine, the patient was still unstable. It was therefore decided to use the Ca2+ sensitizer and vasodilator levosimendan. Application of this new drug resulted in a quick and sustained improvement of hemodynamic parameters and allowed simultaneous treatment with beta-blockers. Conclusion: Levosimendan can be used in addition to beta- and alpha-agonistic agents as well as in the presence of beta-blockers. If the promising results of smaller studies (LIDO, RUSSIAN) with respect to the mortality of the treated patients can be supported by a larger, already initiated study (SURVIVE), levosimendan would be a valuable alternative and/or addition to the conventional therapy of cardiogenic shock.