Cardiogenic shock

Summary

Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion which is frequently associated with multisystem organ failure. CS complicating acute myocardial infarction (AMI) remains common and is associated with high mortality.

The presence of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, informs decisions regarding aggressive therapeutic interventions, triage among alternative hospital care levels, and allocation of clinical resources.

This chapter will outline the underlying causes and diagnostic criteria, the pathophysiology and treatment of cardiogenic shock complicating AMI, including mechanical complications and shock from right heart failure.

There will be a major focus on potential therapeutic angles from the perspective of the interventional cardiologist and also the intensive care perspective on advancement of circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomised trials remains challenging, we will also touch on the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

Introduction

The incidence of cardiogenic shock in patients with AMI differs depending on the definition of cardiogenic shock, but it has...