title: Cardiogenic shock in acute coronary syndrome.
abstract: This is a review of current knowledge on cardiogenic shock (CS), with particular attention to recommended management. The bibliography for the study was compiled through a search of different databases between 1966-2008. The references cited in the selected articles were also reviewed. The selection criteria included all reports published on CS, from case reports and case series to controlled studies. Languages used were Spanish, French, Italian, Portuguese, German, and English. Cardiogenic shock is the most frequent cause of in-hospital death as a complication of acute coronary syndrome. The incidence is about 7% and, despite therapeutic advances, it continues to have an ominous prognosis, with mortality rates of over 50%. Coronary reperfusion is fundamental in the management of cardiogenic shock, particularly with the use of percutaneous coronary intervention. However, if this is not available, systemic thrombolysis may be performed together with balloon counterpulsation or the use of pressor drugs. Despite the historical importance of the Swan-Ganz catheter, this would appear to have limited use, with echocardiography nonetheless having a fundamental role in the management of CS. Although patients with cardiogenic shock often present a left ventricular ejection fraction of around 30%, survivors often have a good functional classification one year after the event. Neurohormonal and inflammatory mechanisms play a fundamental role in the pathophysiology of CS. These mechanisms are currently the target of studies looking into developing new therapeutic strategies.
authors.affiliation: Intensive Care Unit, Emergency and critical Care Service, Medical-Surgical University Hospital, Jaen Hospital Complex, Jaen, Spain. mrb1604@terra.es
authors.forename: Manuel
authors.initials: M
authors.lastname: Ruiz-Bailén
authors.forename: Luis
authors.initials: L
authors.lastname: Rucabado-Aguilar
authors.forename: Manuela
authors.initials: M
authors.lastname: Expósito-Ruiz
authors.forename: Antonia
authors.initials: A
authors.lastname: Morante-Valle
authors.forename: Ana
authors.initials: A
authors.lastname: Castillo-Rivera
authors.forename: Antonio
authors.initials: A
authors.lastname: Pintor-Mármol
authors.forename: Fernando
authors.initials: F
authors.lastname: Rosell-Ortiz
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Mellado-Vergel
authors.forename: Juan
authors.initials: J
authors.lastname: Machado-Casas
authors.forename: Armando
authors.initials: A
authors.lastname: Tejero-Pedregosa
authors.forename: Juan
authors.initials: J
authors.lastname: Lara-Torrano
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000150:complications* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy