Emergency Medicine Cardiogenic shock

Cardiogenic shock is a syndrome characterized by a low cardiac output, elevated left ventricular filling pressure (usually greater than 18 mm Hg) and arterial hypotension (commonly less than 80mm Hg systolic). The commonest cause is extensive left ventricular damage resulting from myocardial infarction and this has a poor prognosis. Other causes, which may be surgically correctable and so have a better prognosis, include rupture of the interventricular septum and papillary muscle dysfunction (Table I). Prompt and accurate haemodynamic assessment of a patient with shock is important as this will characterize the type of shock and provide valuable information on the most appropriate treatment. Inotropic agents, vasodilators and diuretics are the main drugs used in the treatment of cardiogenic shock but they have both potentially beneficial and deleterious effects on myocardial and target organ function.