Management strategies for cardiogenic shock.
OBJECTIVE
Cardiogenic shock remains the most serious complication of acute MI, with an incidence of 6 to 8% and a 30-day mortality rate that remains close to 50%. While cardiogenic shock is due primarily to left ventricular failure, other causes such as acute mitral regurgitation and ventricular septal rupture must always be considered as emergency surgery may be life saving. The purpose of this review is to summarize recent advances in the care of these critically ill patients including the consideration of etiology and pathophysiology as well as the influence of age and adjunctive therapies.


RESULTS
Early revascularization is now an American College of Cardiology/American Heart Association guideline class 1 indication for percutaneous coronary intervention (PCI) particularly for younger patients in cardiogenic shock. Recent studies suggest there may also be a benefit in elderly patients with cardiogenic shock.


CONCLUSIONS
Prompt triage of all patients in cardiogenic shock for early angiography, intra-aortic balloon pump counterpulsation, and early revascularization with PCI or bypass surgery is now the preferred management strategy.
Sanborn
Timothy A
TA
Division of Cardiology , Evanston Northwestern Healthcare, and Department of Medicine, Northwestern University, Feinberg School of Medicine, Evanston, Illinois 60201, USA. tsanborn@enh.org
Feldman
Ted
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000592:standards; D006801:Humans; D008021:Life Support Systems / Q000592:standards; D012770:Shock, Cardiogenic / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate