title: Shock management in acute myocardial infarction.
abstract: OBJECTIVE
  This manuscript outlines the treatment of cardiogenic shock (CS) complicating acute myocardial infarction (AMI), focusing on new therapeutic strategies from the interventional cardiologist's perspective.
  
  
  RESULTS
  CS is a life-threatening complication of AMI occurring in 10% of AMI patients. It can be defined as a state of critical tissue and end-organ hypoperfusion due to reduced cardiac contractility. Early revascularisation is the most important therapeutic measure. Its widespread use has caused a decline in the incidence of CS. However, despite optimal treatment, the mortality rate of CS is still approaches 50%. It is now understood that CS not only involves the heart but the whole circulatory system. In order to increase the survival rates of CS patients, the right decisions have to be taken regarding the optimal revascularisation strategy, treatment with inotropes and vasopressors, mechanical left ventricular support, management of multiorgan dysfunction syndrome, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources.
  
  
  CONCLUSIONS
  CS mortality remains unacceptably high. In the light of very limited evidence regarding most treatment modalities, there is a clear need for adequately designed studies in order to answer the numerous unsettled issues.
authors.affiliation: University Hospital Schleswig-Holstein, Campus Lübeck, Department of Internal Medicine/Cardiology/Angiology/Intensive Care Medicine, Lübeck, Germany.
authors.forename: Janine
authors.initials: J
authors.lastname: Pöss
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000208:Acute Disease; D017052:Hospital Mortality; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D009204:Myocardial Revascularization; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome