From the Research
Introduction to Cardiogenic Shock
Cardiogenic shock is a life-threatening condition characterized by inadequate tissue perfusion due to cardiac dysfunction, often caused by acute myocardial infarction 1. The pathophysiology of cardiogenic shock involves a vicious spiral circle of ischemia, myocardial dysfunction, and multiorgan dysfunction.
Diagnosis of Cardiogenic Shock
Diagnosing cardiogenic shock requires a structured approach, including rapid diagnosis and prompt initiation of therapy to increase blood pressure and augment cardiac output 1. Techniques such as invasive haemodynamic monitoring, measurements of specific biomarkers, and noninvasive bedside echocardiography may be helpful in establishing the diagnosis and determining the aetiology of cardiogenic shock 2.
Treatment of Cardiogenic Shock
The treatment of cardiogenic shock is based on the immediate stabilization of hemodynamic parameters through medical care and the use of mechanical circulatory supports in specialized centers 3. The key to optimal treatment is a structured approach, including:
- Rapid coronary revascularization, which is of critical importance 1
- Inotropic drugs, such as dobutamine, and vasopressors, such as norepinephrine, to achieve adequate perfusion 1, 3
- The use of calcium sensitizer levosimendan, which can be a useful addition to medical therapy 1
- Mechanical circulatory supports, such as intraaortic balloon counterpulsation (IABP), although evidence for improved survival from randomized studies on the use of IABP in combination with PCI is lacking 1
Multidisciplinary Team-Based Management
Timely diagnosis and multidisciplinary team-based management have demonstrated favourable effects on outcomes in cardiogenic shock patients 4. This approach includes:
- Optimization of mechanical ventilation
- Appropriate initiation of renal replacement therapy
- Multi-organ supports needed in this critically ill patient population 4, 3
Caveats and Considerations
The management of cardiogenic shock remains challenging despite recent advances in therapeutic options, and extremely high mortality is still associated with this clinical syndrome 4, 3, 5. Therefore, it is essential to tailor therapies to the specific pathophysiology of each patient and to develop novel therapeutic strategies to reduce the unacceptably high mortality rates currently associated with cardiogenic shock 5.