Cardiogenic Shock and the ICU Patient

Abstract

Cardiogenic shock is one of the most important complications of acute myocardial infarction (MI) and acute left ventricular failure (LVF). It threatens the life of 5-10% of patients with ST-segment elevation myocardial infarction (STEMI) particularly in the presence of inappropriately low peripheral vascular resistance. Cardiogenic shock results in poor tissue perfusion, end-organ damage and carries a high mortality risk. The goal of therapy is to prevent end-organ dysfunction and severe metabolic derangement by raising mean arterial blood pressure, which is achieved with the use of inotropes and vasopressors, often at the expense of tachycardia, elevated myocardial oxygen consumption and extended myocardial ischaemia. Current therapeutic approaches include early coronary artery revascularisation (which has significantly improved the survival rate), fluid resuscitation, inotropic support and mechanical circulatory support using intra-aortic balloon pumps or ventricular assist devices. In this article, we review the pathophysiology, diagnosis and management of cardiogenic shock.

Why is an IABP not the Answer to Cardiogenic Shock after Percutaneous Coronary Intervention? Is it that Noradrenaline helps, Especially by Improving the RV Function in Addition to LV Function? A View Point

“…In the Gusto 1 trial the use of IABP in cardiogenic shock was 35% this increased to 47% in GUSTO III. It was believed that only patients with borderline haemodynamics improved with IABP and the really sick cardiogenic shock patients did not improve [10]. They have commented that in established cardiogenic shock IABP is of dubious value.…”