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Potentially life-threatening emergency
Cardiogenic shock
Other Resources UpToDate PubMed
Potentially life-threatening emergency

Cardiogenic shock

Contributors: Sanuja Bose BS, BA, Tarun Tandon MD, Abhijeet Waghray MD, Ryan Hoefen MD, PhD
Other Resources UpToDate PubMed

Synopsis

Cardiogenic shock is defined by tissue hypoperfusion due to cardiac dysfunction. Frequently cited criteria for establishing the diagnosis include:
  1. Consistent hypotensive state (≥ 30 minutes) with systolic blood pressure of < 90 mm Hg and mean arterial blood pressure of 30 mm Hg below the baseline.
  2. Normal or elevated cardiac filling pressures (left ventricular end-diastolic pressure > 18 mm Hg and/or right ventricular end-diastolic pressure > 10-15 mm Hg).
  3. Severely reduced cardiac output (< 1.8 L/min/m2 and < 2.2 L/min/m2 without and with support, respectively).
Symptoms and signs of cardiogenic shock include lightheadedness, altered mental status, cool extremities or clammy skin, dyspnea, rales, elevated jugular pressure (JVP), narrow pulse pressure, and decreased urinary output (< 30 mL/hour) or increased lactate (> 2 mmol/L). The most prominent physical examination findings include low blood pressure that remains uncorrected with volume replacement and tachycardia.

Etiologies for cardiogenic shock include cardiomyopathy (primarily due to myocardial ischemia / infarction or dilated cardiomyopathy), arrhythmia (including tachyarrhythmias such as sustained ventricular tachycardia and severe bradyarrhythmias such as complete heart block), and mechanical causes (eg, severe aortic or mitral valve disease, severe ventricular septal defects, and left ventricular free wall rupture). Typically, severe depression of myocardial contractility leads to decreased cardiac output and low blood pressure and worsens coronary ischemia. The pathophysiology leading to shock includes the compensatory increase in systemic vascular resistance to compensate for inadequate stroke volume and hypotension, which further exacerbates the issue. Systemic inflammation has also been theorized to play a role by release of interleukins, tumor necrosis factors, and nitric oxide.

Treatment includes establishing adequate circulation with inotropes (eg, dopamine or dobutamine), vasopressors (eg, norepinephrine or dopamine), and/or mechanical support (eg, intra-aortic balloon pump or left ventricular assist device) as well as treatment of the underlying cause (eg, revascularization for ischemia, pacemaker placement for severe bradycardia, or surgical intervention for severe valvular disease, ventricular septal defect, or free wall rupture).

Codes

ICD10CM:
R57.0 – Cardiogenic shock

SNOMEDCT:
89138009 – Cardiogenic shock

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:10/14/2019
Last Updated:05/18/2020
Copyright © 2021 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Cardiogenic shock
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Cardiogenic shock : Chest pain, Fatigue, Hypotension, Cold extremities, Hypoxemia, Metabolic acidosis, Oliguria, Dyspnea, Pallor, Tachypnea
Copyright © 2021 VisualDx®. All rights reserved.