From the Guidelines
Cardiogenic shock is defined as a state of persistent hypotension (SBP < 90 mmHg) despite adequate filling status with signs of hypoperfusion, including oliguria, cold peripheries, altered mental status, lactate > 2 mmol/L, metabolic acidosis, and SvO2 < 65% 1.
Key Characteristics of Cardiogenic Shock
- Hypotension (SBP < 90 mmHg) despite adequate fluid resuscitation
- Signs of hypoperfusion, such as:
- Oliguria (decreased urine output)
- Cold and clammy skin
- Altered mental status
- Elevated lactate levels (> 2 mmol/L)
- Metabolic acidosis
- Low mixed venous oxygen saturation (SvO2 < 65%)
Diagnosis and Management
- Immediate assessment and diagnosis are crucial in cardiogenic shock
- ECG and echocardiography are required immediately in all patients with suspected cardiogenic shock 1
- Invasive monitoring with an arterial line is recommended for accurate blood pressure measurement and to guide therapy
- Treatment involves a combination of medications, such as dobutamine or norepinephrine, to improve heart function and blood pressure, as well as mechanical support devices, like intra-aortic balloon pumps or ventricular assist devices, in severe cases
- Treating the underlying cause of cardiogenic shock, such as a heart attack, is essential and may involve emergency procedures like angioplasty or bypass surgery
Importance of Prompt Treatment
Without prompt and effective treatment, cardiogenic shock has a high mortality rate, ranging from 40% to 80% 1. The key to improving outcomes is breaking the cycle of heart damage and reduced pumping, which leads to further heart muscle damage due to decreased oxygen delivery. Therefore, immediate medical attention and intervention are critical in managing cardiogenic shock.
From the Research
Definition of Cardiogenic Shock
Cardiogenic shock is defined as:
- A clinical syndrome characterized by low cardiac output and sustained tissue hypoperfusion resulting in end-organ dysfunction and death 2
- A condition in which a marked reduction in cardiac output and inadequate end-organ perfusion results from an array of cardiac insults, the most common of which is acute myocardial infarction 3
- A state of profound circulatory failure resulting in insufficient tissue perfusion to meet resting metabolic demands 4
- A clinical syndrome which is defined as the presence of primary cardiac disorder that results in hypotension together with signs of organ hypoperfusion in the state of normovolaemia or hypervolaemia 5
- Characterized by tissue hypoxia caused by circulatory failure arising from inadequate cardiac output 6
Key Characteristics
- In-hospital mortality rates range from 50% to 60% 2
- Requires urgent diagnostic assessment and treatment 5
- Involves a vicious cycle of inflammation, ischemia, and progressive myocardial dysfunction, which often results in death 3
- Requires intensive monitoring accompanied by aggressive hemodynamic support 3
Treatment and Management
- Treatment strategies include inotropic agents, use of intra-aortic balloon counterpulsation, and revascularization 4
- Pharmacologic therapy with the use of vasopressors and inotropes is a key component of treatment strategy 6
- Aggressive, hemodynamically guided medical management with careful monitoring of clinical and hemodynamic parameters with timely use of appropriate mechanical circulatory support devices is often necessary 2