title: Pharmacologic therapies for acute cardiogenic shock.
abstract: OBJECTIVE
  The natural history of cardiogenic shock has improved significantly with the utilization of revascularization and mechanical circulatory support. Despite the interest in identifying new pharmacological agents, the medical therapy to restore perfusion is limited by their side-effects and no solid evidence about improving outcomes. In this article, we review the current pharmacological agents utilized during cardiogenic shock.
  
  
  RESULTS
  Inotropes and vasopressors are widely used to improve hemodynamics acutely; however, reliable information regarding comparative efficacy of individual agents is lacking. A subanalysis of a prospective randomized trial suggested that norepinephrine may be preferred over dopamine in patients with cardiogenic shock. Levosimendan is a new inotrope with calcium sensitization properties that improves acute hemodynamics, but with uncertain effects in mortality. Diuretics are used to decongest patients; however, mortality data are not available. Inhibition of inflammation during cardiogenic shock seems to be a potential therapeutic target; however, initial clinical studies in this area have not shown benefit.
  
  
  CONCLUSIONS
  The current pharmacological treatment for cardiogenic shock includes inotropes, vasopressors and diuretics. The information about comparative effective outcomes is limited and their use should be limited as a temporary measure as a bridge to recovery, mechanical circulatory support or heart transplantation.
authors.affiliation: aDivision of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine bCardiology Section, Veterans Affairs Salt Lake City Healthcare System cDivision of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Nativi-Nicolau
authors.forename: Craig H
authors.initials: CH
authors.lastname: Selzman
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.forename: Josef
authors.initials: J
authors.lastname: Stehlik
mesh_terms: D000893:Anti-Inflammatory Agents / Q000494:pharmacology*; D002316:Cardiotonic Agents / Q000494:pharmacology*; D002986:Clinical Trials as Topic; D057186:Comparative Effectiveness Research; D004232:Diuretics / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D017063:Outcome Assessment, Health Care; D012770:Shock, Cardiogenic / Q000188:drug therapy / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000494:pharmacology*
chemical_list: D000893:Anti-Inflammatory Agents; D002316:Cardiotonic Agents; D004232:Diuretics; D014662:Vasoconstrictor Agents