Assessment of the shock patient and hemodynamic monitoring

Abstract

Cardiogenic shock is a multifaceted syndrome that presents with acute impairment in myocardial function resulting in poor distal end organ perfusion and hypoxia. It is a challenging disease to manage despite innovation in therapeutic options. Revascularization, vasopressor and inotropic support, and mechanical circulatory support are processes commonly used for shock management, however there is limited success in affecting long term outcomes. The impact on long term results may rely on protocols emphasizing early intervention in those presenting with advanced stages of cardiogenic shock. Classifying cardiogenic shock can indeed provide practical, clinically relevant risk stratification to implement appropriate therapies. In this chapter we will review the underlying causes and diagnostic criteria, pathophysiology, hemodynamic markers to assess disease severity, establish the indications for mechanical circulatory support and discuss the shock team approach to improve outcomes.