cardiogenic shock
| "insufficient cardiac output leading to end organ damage" | |
|---|---|
| Etiology | See acute heart failure. |
| Clinical presentation | Fluid-refractory hypotension Highly heterogenous population (see Jung et al 2025 review) - chronic heart failure => long-term compensation mechanisms Ddx: |
| Pathogenesis | |
| Diagnostic investigations | |
| Management | Treat underlying cause - most cardiogenic shock has an ischaemic cause A/B: PEEP can ↓ afterload? C: - Rate: aiming HR 80-100? - Rhythm: sinus rhythm = atrial kick contribution to filling - Preload: tinker with caution - Afterload: - ↑ systemic vascular resistance to improve coronary perfusion? - however shocked patients are usually already maximally vasoconstricted - Inodilators (milrinone, dobutamine) to reduce afterload? - and/or pulmonary vasodilators to reduce RV afterload? - Contractility: - Dobutamine to improve LV contractility |