Cardiogenic Shock

Overview

Cardiogenic shock occurs when severe cardiac dysfunction leads to inadequate cardiac output and systemic tissue hypoperfusion.

Acute myocardial infarction is a common cause, although severe myocarditis, arrhythmia, valvular disease, and advanced heart failure can also produce shock.

Clinical Features

Findings include hypotension, cool extremities, altered mental status, oliguria, tachycardia, and evidence of pulmonary or systemic congestion.

Investigation

Assessment includes ECG, echocardiography, blood gas and lactate, renal and hepatic function, cardiac biomarkers, and evaluation for reversible causes.

Management

Management requires urgent treatment of the cause, restoration of adequate perfusion, careful volume assessment, vasoactive support when required, and specialist critical-care management.

Revascularization is central when acute coronary occlusion is the cause.

Clinical Pearls