Diagnosis and Treatment of Cardiogenic Shock

Cardiogenic shock is the leading cause of death in patients hospitalized with acute myocardial infarction [1, 2]. Cardiogenic shock is characterized by a state of inadequate tissue perfusion due to cardiac dysfunction and is classically manifested by systemic hypotension and end-organ hypoperfusion in the setting of adequate or elevated left ventricular fi lling pressures. The hemody-namic defi nition includes sustained hypotension (systolic blood pressure <90 mm Hg or a decrease >30 mm Hg or more in mean arterial pressure from baseline for at least 30 minutes) and a reduced cardiac index (<2.2 L min⁻¹ m ⁻²) [3]. In the SHould we emergently revascularize Occluded Coronaries for car-diogenic shocK (SHOCK) Trial [4], tissue hypoperfusion was defined as cold peripheries (extremities colder than core), oliguria (<30 mL/h), or both. Subjects requiring pharmacological or mechanical circulatory support to maintain blood pressure are also included in this category.

In the setting of an acute myocardial infarction, hypotension, tachycardia, peripheral vasoconstriction, decreased urine output, and altered mentation are all manifestations of the syndrome, which can range from “preshock” to fully developed pump failure.