Cardiogenic Shock

Overview & definition

Cardiogenic shock is pump failure — the heart cannot maintain cardiac output adequate for tissue perfusion, and the compensatory vasoconstriction only makes it worse. The vicious cycle is the core concept: low cardiac output triggers sympathetic vasoconstriction to defend blood pressure, but the raised afterload further squeezes the stroke volume of an already-failing ventricle, worsening the low output. Mortality is 40 to 50 per cent. Revascularisation if ACS, inotrope and vasopressor support, and mechanical circulatory support for the refractory case are the pillars.^[1][13]

The formal definition: a primary cardiac disorder resulting in clinical and biochemical evidence of tissue hypoperfusion. The clinical criteria are hypotension — SBP of 90 mmHg or less for 30 minutes or more, or vasopressor support needed to hold that pressure — with urine output of 30 mL/hr or less or cool extremities. The haemodynamic criteria are a cardiac index of 2.2 L/min/m2 or less and a PCWP above 15 mmHg. The most common cause is acute myocardial infarction. Cardiogenic shock is not a volume problem or a distribution problem — it is a pump problem.^[15][1]

References20ShowHide

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