Update on the management of cardiogenic shock.
OBJECTIVE
Cardiogenic shock is a life-threatening emergency that occurs frequently with acute coronary syndromes. If rapid myocardial reperfusion following acute myocardial infarction is not obtained, either with thrombolytics or by revascularization, cardiogenic shock frequently develops and the mortality rate is high. This review summarizes recent advances in the pathophysiology, incidence and treatment of cardiogenic shock. Particular attention is given to pharmacologic advances.


RESULTS
Cardiogenic shock continues to occur in 5-10% of patients who suffer a myocardial infarction and the mortality remains over 50% in most studies. Treatment preference is referral to a cardiac center capable of reperfusion using multiple therapies. While no delay in reperfusion is acceptable, emphasis on implementing supportive treatment such as vasopressors, inotropes, and fluids remains critical. There is a wide variance in treatment standards despite established guidelines. Overall mortality from cardiogenic shock has decreased but the incidence remains unchanged.


CONCLUSIONS
Emerging pharmacological interventions designed to counteract the underlying proinflammatory pathophysiologic mechanisms may, in combination with early revascularization, result in improved patient outcomes, but there is no magic bullet on the horizon. Attention to the timeliness of transport and treatment of patients with a focus on revascularization is required for cardiogenic shock patients.
Mann
Henry J
HJ
University Of Minnesota, College of Pharmacy, Department of Experimental and Clinical Pharmacology, Minneapolis, Minnesota, USA. HMann@umn.edu
Nolan
Paul E
PE
D002404:Catheterization; D001026:Coronary Artery Bypass; D006801:Humans; D018836:Inflammation Mediators / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D015424:Reperfusion / Q000379:methods*; D012770:Shock, Cardiogenic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015912:Thrombolytic Therapy; D013997:Time Factors
D018836:Inflammation Mediators