Key Concepts Surrounding Cardiogenic Shock

Authors

Chayakrit Krittanawong, Section of Cardiology, Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, TX. Electronic address: Chayakrit.Krittanawong@bcm.edu.
Mario Rodriguez Rivera, St Louis Missouri, John T. Milliken Department of Medicine, Division of Cardiovascular Disease, Barnes-Jewish Hospital/Washington University in St. Louis School of Medicine.
Preet Shaikh, St Louis Missouri, John T. Milliken Department of Medicine, Barnes-Jewish Hospital/Washington University in St. Louis School of Medicine.
Anirudh Kumar, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
Adam May, St Louis Missouri, John T. Milliken Department of Medicine, Division of Cardiovascular Disease, Section of Critical Care Cardiology, Barnes-Jewish Hospital/Washington University in St. Louis School of Medicine.
Dhruv Mahtta, Section of Cardiology, Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, TX.
Jacob Jentzer, Department of Cardiovascular Medicine; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Andrew Civitello, Section of Cardiology, Baylor College of Medicine, Baylor St. Luke's Medical Center, Texas Heart Institute, Houston, TX.
Jason Katz, Department of Medicine, Division of Cardiology, Duke University, Durham, NC.
Srihari S. Naidu, Department of Cardiology, Westchester Medical Centre, New York Medical College, Valhalla, NY.
Mauricio G. Cohen, Cardiovascular Division, University of Miami Miller School of Medicine, FL.
Venu Menon, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.

Author Type(s)

Faculty

Journal Title

Current Problems in Cardiology

First Page

101303

Document Type

Article

Publication Date

11-1-2022

Department

Medicine

Abstract

Cardiogenic shock (CS) is the final common pathway of impaired cardiovascular performance that results in ineffective forward cardiac output producing clinical and biochemical signs of organ hypoperfusion. CS represents the most common cause of shock in the cardiac intensive care unit (CICU) and accounts for a substantial proportion of CICU patient deaths. Despite significant advances in revascularization techniques, pharmacologic therapeutics and mechanical support devices, CS remains associated with a high mortality rate. Indeed, the prevalence of CS within the CICU appears to be increasing. CS can be differentiated as phenotypes reflecting different metabolic, inflammatory, and hemodynamic profiles, depending also on anatomic substrate and congestion profile. Future prospective studies and clinical trials may further characterize these phenotypes and apply targeted intervention for each phenotype and SCAI SHOCK stage rather than a one-size-fits-all approach. Overall, there are 8 key concepts of CS; 1) the mortality associated with CS; 2) Shock attributed to AMI may be declining in both incidence and associated mortality; 3) providers should think about hemodynamic, metabolic, inflammation and cardiac function in totality to assess CS; 4) CS is a dynamic process; 5) no randomized trials evaluating use of the PAC in patients with CS; 6) most data supporting neosynephrine as first line agent in CS; 7) most registries suggest that almost half of CS patients do not have any mechanical support, and the vast majority of the remainder utilize the IABP; and 8) patients with AMI CS should receive emergent PCI of the culprit vessel.

Recommended Citation

Krittanawong, C., Rivera, M. R., Shaikh, P., Kumar, A., May, A., Mahtta, D., Jentzer, J., Civitello, A., Katz, J., Naidu, S. S., Cohen, M. G., & Menon, V. (2022). Key Concepts Surrounding Cardiogenic Shock. Current Problems in Cardiology, 47 (11), 101303. https://doi.org/10.1016/j.cpcardiol.2022.101303