(See Chap. 11. Shock) Severe LV failure with hypotension (bp <90 mmHg), elevated PCW (>20 mmHg), cardiac index <2.2 L/min/m2, accompanied by oliguria, peripheral vasoconstriction, dulled sensorium, and metabolic acidosis.
Treatment: Cardiogenic Shock Swan-Ganz catheter and intraarterial bp monitoring are not always essential but may be helpful; aim for mean PCW of 18-20 mmHg with adjustment of volume (diuretics or infusion) as needed (Fig. 119-3). Vasopressors (e.g., norepinephrine or dopamine [Table 119-1]) and/or intraaortic balloon counterpulsation may be necessary to maintain systolic bp >90 mmHg and reduce PCW. Administer high concentration of O2 by mask; if pulmonary edema coexists, consider bilateral positive airway pressure (BiPAP) or intubation and mechanical ventilation. Acute mechanical complications (see below) should be sought and promptly treated. If cardiogenic shock develops within 36 h of acute STEMI, reperfusion by PCI or coronary artery bypass grafting (CABG) may markedly improve LV function. |