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Cardiogenic shock

Author(s): Maria Monica Lopez Rodriguez, Carlos Javier Vizcaino Guerrero, Juan Camilo Arcia Garzon, Daniel Forero Henao Paola Andrea Ortiz Marin, Andres Felipe Segura Avila and Juan David Vega Padilla

Introduction: The cardiogenic shock is a state of endorgan dysfunction, secondary to insufficient cardiac output despite adequate preload, as a result of left ventricular, right ventricular or biventricular dysfunction. Cardiogenic shock occurs in up to 10% of patients presenting with acute myocardial infarction and is the leading cause of death.

Objective: To conduct a review of cardiogenic shock.

Methodology: The search was performed in the databases PUBMED/MEDLINE, EMBASE and Google Scholar with the search terms: Cardiogenic shock and Epidemiology or Pathophysiology or Diagnosis or Treatment. We selected the most relevant studies on cardiogenic shock.

Results: We provided a general description of the definition, epidemiology, clinical manifestations, causes, pathophysiology and treatment of cardiogenic shock. The clinical syndrome of cardiogenic shock has been described as: a systolic blood pressure of less than 90 mm Hg, or greater than 30 mm Hg below baseline BP, for at least 30 minutes, with signs of a reduced cardiac output. The most common cause of cardiogenic shock is acute coronary syndrome, accounting for about 70% to 80% of cardiogenic shock cases. The basic treatment measures include initial stabilization with volume expansion to obtain euvolaemia, vasopressors, and inotropes plus additional therapy for the prevention or treatment of multiorgan system dysfunction. Norepinephrine is associated with fewer arrhythmias and may be the vasopressor of choice in many patients with cardiogenic shock. Coronary reperfusion is the main evidence-based therapeutic intervention for patients with acute MI presenting with cardiogenic shock. Traditionally, intra-aortic balloon pumps have been the main support system, there has been interest in improved mechanical support devices because these may make revascularization safer.

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