Causes of Cardiogenic Shock and Their Management
| Cause | Pulmonary oedema | Management |
|---|---|---|
| Acute myocardial infarction (MI) (typically STE-ACS, but may occur in NSTE-ACS) | Usually present, except when due to right ventricular infarction | Reperfusion with percutaneous coronary intervention (PCI) Coronary artery bypass grafting may be considered for chronic total occlusions untreatable by PCI |
| Ventricular septal rupture complicating myocardial infarction | Often present | Surgical repair, sometimes with a period of stabilization using intra-aortic balloon counterpulsation and/or left ventricular assist device |
| Papillary muscle rupture complicating myocardial infarction | Always present | Surgical repair |
| Right ventricular infarction (typically occurs in association with inferior myocardial infarction) | Usually absent | Reperfusion with PCI if appropriate Optimization of heart rate and AV conduction Optimization of right atrial (central venous) pressure Inotropic-vasopressor therapy if needed |
| Stress (Takotsubo) cardiomyopathy | Often present | Inotropic-vasopressor therapy if needed |
| Acute myocarditis | Often present | Mechanical circulatory support may indicated for some patients |
Other causes of left ventricular disease Related to persistent tachyarrhythmia Severe hypertension Dilated cardiomyopathy/end-stage hypertrophic cardiomyopathy Septic cardiomyopathy Post-cardiac arrest Complicating multi-organ failure | Often present | Treat underlying disease |
Acute tachyarrhythmia | Typically present when associated with valve disorder, for example severe aortic stenosis, or severely impaired left ventricular function | Cardioversion to restore sinus rhythm or control of ventricular rate (if atrial fibrillation/flutter with rapid ventricular response) |
Critical aortic or mitral stenosis (Chapter51) | Usually present | Surgery or a transcatheter procedure including balloon valvotomy (for mitral stenosis or aortic stenosis) or a transcatheter valve implant (aortic stenosis) |
Acute aortic or mitral regurgitation (Chapter51) | Always present | Surgical valve replacement (for aortic or mitral regurgitation) or percutaneous procedure (some patients with mitral regurgitation) |
Acute major pulmonary embolism (Chapter57) | Not present | Thrombolysis |
Cardiac tamponade (Chapter54) | Not present | Pericardiocentesis |