Cardiogenic shock.

Abstract

Mortality rates in patients with cardiogenic shock remain frustratingly high. Its pathophysiology involves a downward spiral in which ischemia causes myocardial dysfunction, which in turn worsens ischemia. Areas of viable but nonfunctional myocardium can contribute to the development of cardiogenic shock. Rapid diagnosis and prompt initiation of supportive therapy to maintain blood pressure and cardiac output, followed by expeditious coronary revascularization, are crucial. The SHOCK multicenter randomized trial has provided important new data that support a strategy of emergent cardiac catheterization and revascularization with angioplasty or coronary surgery when feasible. This strategy can improve survival and represents standard therapy at this time. In hospitals without direct angioplasty capability, stabilization with IABP and thrombolysis followed by transfer to a tertiary care facility may be the best option.