NYMC Faculty Publications
Key Concepts Surrounding Cardiogenic Shock
Author Type(s)
Faculty
DOI
10.1016/j.cpcardiol.2022.101303
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