ICU learning pathway | Cardiogenic shock

Cardiogenic shock
Session Overview
Description
Cardiogenic shock is acute heart failure in its most severe form. This session defines the condition and explores its causes, diagnosis and management.

By the end of this session you will be able to:

• Identify the most common causes and severity of cardiogenic shock
• Explain the need for urgency in the early recognition and appropriate management of cardiogenic shock
• Recognise how diversity of presentation of cardiogenic shock is linked to its aetiology
• Identify the appropriate management of cardiogenic shock
• Describe the current management of myocardial ischaemia, infarction and cardiac reperfusion strategies

Before commencing this session you should complete the following sessions:

• Blood gas analysis (001-0254)
• Myocardial Infarction (001-0298)

Cardiogenic shock is acute heart failure in its most severe form. The clinical definition is:

Decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume.

The haemodynamic criteria for cardiogenic shock are:

• Systolic hypotension (<90 mmHg)
• Reduced cardiac index (<2.2 L/min/m2)

Cardiogenic shock describes a heart unable to supply adequate oxygen and nutrients to meet the demands of the body's metabolising tissues. In this setting, cardiogenic shock carries a very high mortality rate because the hypoperfusion causes profound microcirculatory disturbances in all organ systems.

European registry data suggests that the incidence of cardiogenic shock complicating acute myocardial infarction (MI) has decreased over the past decade to 5.7% of acute MI [1](read details regarding the reference). Also, 30-day mortality after MI has fallen, but remains considerably higher in patients with cardiogenic shock (60.9%) versus those without cardiogenic shock (5.2%).