Cardiogenic shock

Abstract

Circulatory shock is characterized by inadequate systemic tissue perfusion due to altered physiology and reduced blood supply. Tissue perfusion, a function of systemic vascular resistance (SVR) and cardiac output (CO), is significantly reduced when SVR is low and CO is elevated, or where SVR is elevated and CO is reduced. Depressed CO with elevated SVR in the presence of adequate intravascular volume indicates cardiogenic shock (CS). CS due to Left ventricular (LV) pump failure is characterized by certain physical, laboratory, and hemodynamic parameters. Addressing metabolic perturbations, respiratory insufficiency, arrhythmias, and supportive care take on special urgency with CS. Ventricular septal rupture (VSR) complicating myocardial infarction (MI) was responsible for 3" of CS in the SHOCK Registry and represents a particularly challenging group because of the difficulties of operative management and very poor prognosis. Patients presenting with subacute free wall rupture (FWR) and hemopericardium appear to have survival rates similar to CS due to LV pump failure.