Abstract
Cardiogenic shock (CS) results from low cardiac output due to myocardial dysfunction coupled with systemic end-organ tissue hypoperfusion and elevated ventricular filling pressures along a spectrum of shock severity. This narrative review aims to compare the epidemiology, pathophysiology and contemporary management of two common etiologies of CS due to acute myocardial infarction (AMI-CS) and advanced heart failure (HF-CS). CS complicates up to 14% of AMI and 5% of HF admissions. Rapid therapeutic intervention after prompt recognition of CS etiology is the mainstay towards improving clinical outcomes and mitigating end-organ sequelae and death. In AMI-CS, persistent hypotension often leads to subsequent hypoperfusion and congestion, and early culprit coronary artery lesion revascularization is critical. In HF-CS, congestion often precedes hypoperfusion and hypotension, and targeting the underlying non-ischemic cause of myocardial dysfunction is key. Tailoring of hemodynamic strategies with vasoactive agents and temporary mechanical circulatory and end-organ support to manage the predominant ventricular failure, hemo-metabolic phenotypes, and shock severity associated with each etiology are discussed. Given the limited evidence-base in CS care, we also highlight potential knowledge gaps ripe for future exploration.
Published Version
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