cardiogenic shock

Jun 21st, 2015
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cardiac dysfunction, most often systolic. It is a major, and frequently fatal, complication of a variety of acute and chronic disorders, occurring most commonly following acute myocardial infarction (MI).

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BackgroundCardiogenic shock is a physiologic state in which inadequate tissue perfusion results from cardiac dysfunction, most often systolic. It is a major, and frequently fatal, complication of a variety of acute and chronic disorders, occurring most commonly following acute myocardial infarction (MI). (See Pathophysiology, Etiology, and Prognosis.) Although ST-segment elevation MI (STEMI, previously termed Q-wave MI) is encountered in most patients, cardiogenic shock may also develop in patients with non ST-segment elevation acute coronary syndrome (NSTEMI, NSTACS, or unstable angina). (See the images below.)Patient with an acute anterolateral myocardial infarction who developed cardiogenic shock. Coronary angiography images showed severe stenosis of the left anterior descending coronary artery, which was dilated by percutaneous transluminal coronary angioplasty. Echocardiogram image from a patient with cardiogenic shock shows enlarged cardiac chambers; the motion study showed poor left ventricular function. Courtesy of R. Hoeschen, MD. The clinical definition of cardiogenic shock is decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume. Hemodynamic criteria for cardiogenic shock are sustained hypotension (systolic blood pressure < 90 mm Hg for at least 30 min) and a reduced cardiac index (< 2.2 L/min/m2) in the presence of elevated pulmonary capillary wedge pressure (>15 mm Hg). (See DDx, Workup.) Cardiogenic s

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