Cardiogenic shock

Cardiogenic shock occurs when the heart is not able to pump enough blood to generate adequate cardiac output to maintain normal blood pressure. This frequently occurs in the setting of a large myocardial infarction, however other causes include acute valvular regurgitation, non-ischemic cardiomyopathies and arrhythmia.

One of the life-threatening complications of STEMI is cardiogenic shock during which hypotension is present from low cardiac output. This results in end-organ hypoperfusion and potentially multi-system organ failure and can be fatal. Revascularization by PCI or CABG is recommended in this setting (see SHOCK trial). Hemodynamic support may be needed using intraaortic balloon counterpulsation (IABP or balloon pump) and when severe left ventricular assist device insertion (LVAD).

Treatment of cardiogenic shock is aimed at correcting the primary etiology and hemodynamic support with cardiac inotropes such as dobutamine or milrinone.