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Cardiogenic Shock

  • A. Boujoukos
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 28)

Abstract

Cardiogenic shock is defined by poor systemic perfusion despite adequate volume due to a low cardiac output so that basal metabolic needs of a patient cannot be met. Hemodynamically, a low cardiac index (CI) of < 1.8–2.11/min/m2 is coupled with an elevated arteriovenous oxygen difference and a low mixed venous oxygen saturation. The clinical presentation of cardiogenic shock is variable depending on the acuity of onset and the ability of the body to compensate for the progressive decline in cardiac output. In previously healthy patients, an abrupt loss of left ventricular (LV) function following an extensive myocardial infarction (MI) often results in diaphoresis, tachycardia, frank or relative hypotension and cool, clammy, vasoconstricted extremities. Confusion, oliguria, lactic acidosis and evidence of respiratory muscle fatigue manifest as sequellae of end organ hypoperfusion. Systemic hypotension fuels the ventricular failure further by reducing coronary perfusion and increasing the ischemic insult to already hypoper-fused myocardium. Less dramatic initial presentations are often evident in patients in whom the deterioration in cardiac output is more insidious. Fatigue, anorexia, progressive tachycardia, a drop in blood pressure from baseline, and oliguria with rising blood urea nitrogen and creatinine may be seen well in advance of the frank hypotension. A state of compensated low output with normal systemic blood pressure can often be maintained chronically though the lack of cardiovascular reserve may quickly, with minimal insult, precipitate a state where perfusion and oxygen delivery do not meet the body’s needs leading to a state of overt shock.

Keywords

Coronary Artery Bypass Grafting Right Ventricular Cardiogenic Shock Mean Arterial Blood Pressure Ventricular Assist Device 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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© Springer-Verlag Berlin Heidelberg 1997

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  • A. Boujoukos

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