Cardiogenic shock

Abstract

Cardiogenic shock (CS) is a serious condition of systemic hypoperfusion due to impaired cardiac pump function, often resulting in multiple organ failure. The most common cause of CS is left ventricular failure resulting from extensive acute myocardial infarction (AMI); other causes of CS include mechanical complications of AMI, right ventricular infarction, terminal-stage cardiomyopathy, arrhythmias, acute fulminant myocarditis, and post-cardiac arrest states. Despite early revascularization, the mortality of CS as a complication of AMI remains to be around 50%, making it one of the leading causes of death among the patients with AMI. Every patient with signs and symptoms of CS should be transferred to a specialist heart centre, allowing to perform immediate selective coronary angiography and possible revascularization using PCI for 24 hours and having specialist intensive care for these patients with a possibility to provide short-term acute mechanical circulatory support (AMCS). Although the use of inotropic and vasopressor agents cannot be avoided, their long-term administration leads to severe adverse consequences, including the development of both ventricular and atrial arrhythmias, increased myocardial oxygen consumption, direct toxic effect on cardiomyocytes, and worse survival. For these reasons, the use of short-term percutaneous AMCS has been increasing. The issue of timing and of the most suitable type of this support in order to affect mortality remains unclear so far. Experience with an early use of MCS in patients with terminal stage of chronic heart failure that resulted in improved survival also supports this notion in those with CS due to AMI. The development of a specialized team of experts for the management of CS with a multidisciplinary organization is a reasonable condition for rational treatment and better outcomes, as in other life-threatening conditions.