Cardiogenic Shock Questions & Answers

Updated: Aug 06, 2019
  • Author: Xiushui (Mike) Ren, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Questions & Answers

Overview

What is cardiogenic shock?

What is the role of invasive hemodynamic monitoring in the diagnosis of cardiogenic shock?

What are the signs and symptoms of cardiogenic shock?

Which physical findings are characteristic of cardiogenic shock?

Which lab studies are performed in the diagnosis of cardiogenic shock?

What is the role of imaging studies in the diagnosis of cardiogenic shock?

What is the role of electrocardiography in the diagnosis of cardiogenic shock?

What is included in the emergency management of cardiogenic shock?

Which invasive procedures are performed in the treatment of cardiogenic shock?

What are the pharmacologic treatment options for cardiogenic shock?

What is the role of dopamine in the treatment of cardiogenic shock?

What is the role of dobutamine in the treatment of cardiogenic shock?

What is the role of vasoconstrictors in the treatment of cardiogenic shock?

What is the role of phosphodiesterase in the treatment of cardiogenic shock?

What is the role of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in the treatment of cardiogenic shock?

What is cardiogenic shock?

Which patients are at highest risk for cardiogenic shock?

What is the clinical definition for cardiogenic shock?

How is cardiogenic shock diagnosed?

How is circulatory shock categorized?

What are characteristics of cardiogenic shock?

What are characteristics of hypovolemic shock?

What are characteristics of obstructive shock?

What are characteristics of distributive shock?

What information about cardiogenic shock should patients receive?

What is the pathophysiology of cardiogenic shock?

What is the myocardial pathology of cardiogenic shock?

What is the cellular pathology of cardiogenic shock?

What is the role of myocardial stunning in the pathogenesis of cardiogenic shock?

What are the cardiovascular mechanics of cardiogenic shock?

What is the role of LV pump function in the pathogenesis of cardiogenic shock?

What is the role of depressed myocardial function in the pathogenesis of cardiogenic shock?

What is the role of fluid retention in the pathogenesis of cardiogenic shock?

What is the role of excessive myocardial oxygen demand in the pathogenesis of cardiogenic shock?

What is the role of metabolic derangements in the pathogenesis of cardiogenic shock?

What is shock state in cardiogenic shock?

Which cardiac dysfunctions can cause cardiogenic shock?

What is the most common cause of cardiogenic shock?

Which complications of acute myocardial infarction (MI) may result in cardiogenic shock?

What is the role of medication in the etiology of cardiogenic shock?

What is the role of viral infections in the etiology of cardiogenic shock?

What is the role of systemic inflammatory response in the etiology of cardiogenic shock?

What are the causes of systolic dysfunction leading to cardiogenic shock?

What are the causes of diastolic dysfunction leading to cardiogenic shock?

What causes increased afterload in cardiogenic shock?

What is the role of valvular dysfunction in the etiology of cardiogenic shock?

What are the valvular and structural abnormalities associated with cardiogenic shock?

What causes reduced myocardial contractility in cardiogenic shock?

What can cause afterload increase associated with right ventricle (RV) failure in cardiogenic shock?

What is the role of arrhythmias in the etiology of cardiogenic shock?

What is the prevalence of cardiogenic shock in the US?

What is the global prevalence of cardiogenic shock?

What are the racial predilections for cardiogenic shock?

How does the prevalence of cardiogenic shock vary by sex?

How does the prevalence of cardiogenic shock vary by age?

What is the prognosis of cardiogenic shock?

What are the mortality rates for cardiogenic shock?

What are the race stratified mortality rates from cardiogenic shock?

What is the significance of right ventricle (RV) dilation on echocardiography (echo) in cardiogenic shock?

What are the complications of cardiogenic shock?

Which factors increase the risk for mortality in patients with cardiogenic shock?

Which echocardiographic findings increase the risk of mortality from cardiogenic shock?

What can improve outcomes in cardiogenic shock?

Presentation

Why is a complete clinical assessment required in patients with cardiogenic shock?

How does cardiogenic shock develop following acute myocardial infarction (MI)?

What are the signs and symptoms of myocardial infarction (MI) with cardiogenic shock?

What is the focus of the medical history of patients with cardiogenic shock?

What are symptoms of poor cardiac function in patients with cardiogenic shock?

How is cardiogenic shock diagnosed?

How is cardiogenic shock diagnosed from physical exam?

What are the characteristics of cardiogenic shock?

What is the significance of systolic murmur in cardiogenic shock?

DDX

Which conditions should be included in the differential diagnoses of cardiogenic shock?

How is right ventricular (RV) infarction diagnosed in patients with cardiogenic shock?

What is the prognosis of cardiogenic shock with RV infarction?

What is the initial management of cardiogenic shock due to right ventricular (RV) infarction?

What is the role of inotropic therapy in the treatment of cardiogenic shock?

What is the role of percutaneous transluminal coronary angioplasty (PTCA) in the treatment of cardiogenic shock?

What are characteristics of mitral regurgitation in cardiogenic shock?

What is the role of echocardiography in the diagnosis of cardiogenic shock?

How is hemodynamic stabilization achieved in cardiogenic shock?

When does rupture of free wall of the left ventricle (LV) occur in patients with cardiogenic shock?

What are the clinical presentations of cardiac rupture in cardiogenic shock?

What are the physical findings of ventricular septal rupture in cardiogenic shock?

What confirms the diagnosis of acute myocardial infarction (MI) in patients with cardiogenic shock?

How is myocardial infarction (MI) with cardiogenic shock treated?

What is the prognosis of cardiogenic shock due to ventricular septal rupture?

What are some other causes of severe, reversible myocardial dysfunction leading to cardiogenic shock?

How does myocardial dysfunction vary in patients with cardiogenic shock?

What are the differential diagnoses for Cardiogenic Shock?

Workup

What are the keys to achieving a good prognosis for cardiogenic shock?

What is included in the workup of cardiogenic shock?

What is the role of brain natriuretic peptide (BNP) in the diagnosis of cardiogenic shock?

What is the role of lab testing in the diagnosis of cardiogenic shock?

What is the role of complete blood count (CBC) in the diagnosis of cardiogenic shock?

What is the role of cardiac enzyme measurement in the diagnosis of cardiogenic shock?

What is the role of cardiac troponin testing in the diagnosis of cardiogenic shock?

What is the role of arterial blood gas (ABG) values in the diagnosis of cardiogenic shock?

What is the role of serum lactate measurement in the diagnosis of cardiogenic shock?

When is echocardiography performed in the evaluation of cardiogenic shock?

What may be revealed on echocardiogram in the evaluation of cardiogenic shock?

What is the role of chest radiography in the diagnosis of cardiogenic shock?

What is the role of ultrasonography in the diagnosis of cardiogenic shock?

What is the role of coronary angiography in the diagnosis of cardiogenic shock?

What may be revealed from coronary angiography in the evaluation of cardiogenic shock?

What is the most common cause of cardiogenic shock?

What is the basis for diagnosis of acute myocardial ischemia in patients with cardiogenic shock?

What is the role of invasive hemodynamic monitoring in the diagnosis of cardiogenic shock?

Treatment

What is the initial approach to cardiogenic shock in the emergency department (ED)?

When is admission to an ICU indicated in the treatment of cardiogenic shock?

What is the most important intervention for improving survival in patients with cardiogenic shock?

Which electrolyte and acid-base abnormalities require immediate correction in cardiogenic shock?

How is cardiogenic shock prevented?

Why is a central line needed in patients with cardiogenic shock?

What is the role of a pulmonary artery catheter in the management of cardiogenic shock?

What is the role of an arterial line in the management of cardiogenic shock?

What is the role of mechanical circulatory support (MCS) in the treatment of cardiogenic shock?

What is the role of PCI and CABG in the treatment of cardiogenic shock?

What is included in prehospital care for cardiogenic shock?

What is the benefit of 12-lead ECG in the prehospital care of cardiogenic shock?

When are inotropic medications indicated in the prehospital care of cardiogenic shock?

Which ventilation methods may be clinically necessary in the prehospital care of cardiogenic shock?

What is included in the initial management of cardiogenic shock?

What is required for oxygenation and airway protection in patients with cardiogenic shock?

What are the benefits of extracorporeal cardiopulmonary resuscitation (CPR) in the treatment of cardiogenic shock?

What treatment is required for all patients with cardiogenic shock?

What is included in the pharmacologic therapy of cardiogenic shock?

What is the role of vasoconstricting drugs in the treatment of cardiogenic shock?

How is inadequate tissue perfusion treated in cardiogenic shock?

How is hemodynamic support provided in cardiogenic shock?

What is the role of dopamine in the treatment of cardiogenic shock?

What is the role of norepinephrine in the treatment of cardiogenic shock?

What is the role of epinephrine in the treatment of cardiogenic shock?

What is the role of levosimendan in the treatment of cardiogenic shock?

What is the role of dobutamine in the treatment of cardiogenic shock?

What is the role of phosphodiesterase III inhibitors in the treatment of cardiogenic shock?

What is the role of thrombolytic therapy in the treatment of cardiogenic shock?

What is the efficacy of combination thrombolytic therapy and intra-aortic balloon pump (IABP) in the treatment of cardiogenic shock?

What is the role of an intra-aortic balloon pump (IABP) in the treatment of cardiogenic shock?

What is the frequency of complications from intra-aortic balloon pump (IABP) in the treatment of cardiogenic shock?

How does treatment with an intra-aortic balloon pump (IABP) affect long-term survival of cardiogenic shock?

What is the role of left ventricular (LV) assist devices (LVADs) in the treatment of cardiogenic shock?

When are implantable left ventricular (LV) assist devices (LVADs) indicated in the treatment of cardiogenic shock?

What are the contraindications for use of left ventricular (LV) assist devices (LVADs) in the treatment of cardiogenic shock?

What are the indications for the insertion of a ventricular assist device (VAD) in the treatment of cardiogenic shock?

How is left ventricular (LV) function improved in cardiogenic shock?

What are the benefits of angioplasty for the treatment of cardiogenic shock?

Which factors increase mortality risk in patients with cardiogenic shock?

What is the effectiveness of coronary artery bypass grafting (CABG) for the treatment of cardiogenic shock?

What is the efficacy of early revascularization for the management for cardiogenic shock?

What are the 6 month mortality rates associated with early revascularization to treat cardiogenic shock?

What are the 1 year mortality rates associated with early revascularization to treat cardiogenic shock?

What are the long-term benefits of early revascularization to treat cardiogenic shock?

What are the transfer recommendations for patients with cardiogenic shock?

How is cardiogenic shock prevented?

Which specialist consultations are needed for the management of cardiogenic shock?

Guidelines

Which organizations have released treatment guidelines for cardiogenic shock?

According to ACCF/AHA guidelines, who is at highest risk of developing cardiogenic shock?

What are the ACCF/AHA treatment guidelines for cardiac shock with ST-segment elevation myocardial infarction (STEMI)?

What are the ESC treatment guidelines for cardiogenic shock?

What are the AHA/ACC treatment guidelines for cardiogenic shock in non–ST-elevation acute coronary syndrome (ACS) (NSTE-ACS)?

Which organizations have released guidelines for mechanical circulatory support (MCS) in cardiogenic shock?

What are the SCAI/ACC/HFSA/STS guidelines for use of mechanical circulatory support (MCS) in cardiogenic shock?

What are the ISHLT guidelines for use of long-term mechanical circulatory support (MCS) in cardiogenic shock?

Medications

What is the indication for vasopressors in the treatment of cardiogenic shock?

How do vasodilators treat cardiogenic shock?

What is the indication for diuretics in the treatment of cardiogenic shock?

Which medications in the drug class Cardiovascular, Other are used in the treatment of Cardiogenic Shock?

Which medications in the drug class Diuretics, Loop are used in the treatment of Cardiogenic Shock?

Which medications in the drug class Opioid Analgesics are used in the treatment of Cardiogenic Shock?

Which medications in the drug class Antiplatelet Agents, Cardiovascular are used in the treatment of Cardiogenic Shock?

Which medications in the drug class Vasodilators are used in the treatment of Cardiogenic Shock?

Which medications in the drug class Inotropic Agents are used in the treatment of Cardiogenic Shock?