Materiały źródłowe

• #1 Cardiogenic shock – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cardiogenic-shock/diagnosis-treatment/drc-20366764

  Cardiogenic shock is usually diagnosed in an emergency setting. Doctors will check for signs and symptoms of shock, and will then perform tests to find the cause. Tests might include: […] Blood pressure measurement. People in shock have very low blood pressure. […] Electrocardiogram (ECG or EKG). This quick, noninvasive test records the electrical activity of your heart using electrodes attached to your skin. If you have damaged heart muscle or fluid buildup around your heart, the heart won’t send electrical signals normally. […] Chest X-ray. A chest X-ray shows the size and shape of your heart and whether there’s fluid in your lungs. […] Blood tests. You’ll have blood drawn to check for organ damage, infection and heart attack. An arterial blood gas test might be done to measure oxygen in your blood.

• #2 Cardiogenic Shock – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/cardiogenic-shock/diagnosis

  To diagnose cardiogenic shock, your doctor will usually do tests after you have been admitted to the hospital for a possible heart attack or for symptoms of shock. […] Your doctor may order one or more of the following tests and procedures to diagnose cardiogenic shock. […] Low blood pressure that does not return to normal on its own is a sign of cardiogenic shock. […] Coronary angiography is a procedure that uses contrast dye, usually containing iodine, and X-ray pictures to detect blockages in the coronary arteries that are caused by plaque buildup. […] Echocardiography, or echo, is a painless test that uses sound waves to create moving pictures of your heart. […] An electrocardiogram, also called an ECG or EKG, is a simple, painless test that detects and records your hearts electrical activity.

• #3 Cardiogenic Shock – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482255/

  Cardiogenic shock is defined as a primary cardiac disorder that results in both clinical and biochemical evidence of tissue hypoperfusion. Clinical criteria include a systolic blood pressure of less than or equal to 90 mm Hg for greater than or equal to 30 minutes or support to maintain systolic blood pressure less than or equal to 90 mm Hg and urine output less than or equal to 30 mL/hr or cool extremities. Hemodynamic criteria include a depressed cardiac index (less than or equal to 2.2 liters per minute per square meter of body surface area) and an elevated pulmonary-capillary wedge pressure greater than 15 mm Hg. […] Diagnostic evaluation of cardiogenic shock includes the following: Complete blood picture, comprehensive metabolic panel, magnesium, phosphorous, coagulation profile, thyroid-stimulating hormone, Arterial blood gas, Lactate, Brain natriuretic peptide, Cardiac enzyme test, Chest x-ray, Electrocardiogram, Two-dimensional echocardiography, Ultrasonography to guide fluid management, Coronary angiography. […] Rapid diagnosis with prompt supportive therapy and coronary artery revascularization plays a vital role in achieving good outcomes in patients with cardiogenic shock.

• #4 Clinical manifestations and diagnosis of cardiogenic shock in acute myocardial infarction – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-cardiogenic-shock-in-acute-myocardial-infarction

  Clinical manifestations and diagnosis of cardiogenic shock in acute myocardial infarction […] Cardiogenic shock is a clinical condition of inadequate tissue (end-organ) perfusion due to the inability of the heart to pump an adequate amount of blood. The clinical manifestations and diagnosis of cardiogenic shock in acute myocardial infarction (MI) will be reviewed here. […] Patients with cardiogenic shock usually have a low cardiac index (<2.2 L/min/m²) and elevated ventricular filling pressures (ie, pulmonary capillary wedge pressure [PCWP] >15 mmHg and/or central venous pressure [CVP] >10 mmHg), and a decreased mixed venous oxygen saturation. […] Failure of the left or right ventricle (due to myocardial muscle dysfunction) to pump an adequate amount of blood is the primary cause of cardiogenic shock in acute MI. Hypotension, tissue hypoperfusion, and pulmonary congestion or systemic venous congestion result.

• #5 Cardiogenic Shock Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/152191-workup

  As previously discussed, the keys to achieving a good outcome in patients with cardiogenic shock are rapid diagnosis, prompt supportive therapy, and expeditious coronary artery revascularization in patients with myocardial ischemia and infarction. […] Any patient presenting with shock must receive an early working diagnosis, urgent resuscitation, and subsequent confirmation of the working diagnosis. […] In addition to laboratory studies, workup in cardiogenic shock can include imaging studies such as echocardiography, chest radiography, and angiography; ECG; and invasive hemodynamic monitoring to determine the primary mechanism causing the acute hemodynamic instability. […] The 2019 American Heart Association (AHA) scientific statement on contemporary management of cardiogenic shock recommends including the following laboratory studies: complete blood cell (CBC) count; levels of electrolytes, creatinine, lactate, and serial cardiac troponin; hepatic function studies; and arterial blood gas (ABG).

• #6 Cardiogenic Shock: Past, Present, and Future Outlook | USC Journal

  https://www.uscjournal.com/articles/cardiogenic-shock-management-and-research-past-present-and-future-outlook?language_content_entity=en

  Although great strides have been made in the pathophysiological understanding, diagnosis and management of cardiogenic shock (CS), morbidity and mortality in patients presenting with the condition remain high. […] Therapeutic intervention is often time critical, not least to minimize secondary end-organ damage, so early diagnosis is key. […] Recently, Chioncel et al. again highlighted the significance of early detection of tissue hypoperfusion in patients with evolving or established CS. […] In this context, hypotension is no longer a required criterion, and the definition now includes normotensive CS. […] Baran et al. presented the Society for Cardiovascular Angiography and Interventions (SCAI) clinical expert consensus statement on the classification of cardiogenic shock, defining a grading system of CS ranging from stage A with patients At risk, through to B and C (Beginning and Classic CS) then to D and E (Deteriorating patients and those in Extremis).

• #7 Cardiogenic Shock: Risk Factors, Causes and Symptoms

  https://my.clevelandclinic.org/health/diseases/17837-cardiogenic-shock

  Cardiogenic shock is a serious condition that happens when your heart cant supply enough oxygen-rich blood to your body to meet its needs. It can be fatal when a lack of oxygen causes your organs to fail. […] This condition is an emergency situation that requires immediate treatment in a hospital. […] Your healthcare provider will want to know your medical history, including symptoms youre having that day or that you had recently. During a physical exam, they may find these signs of cardiogenic shock: A weak pulse. Skin that feels cold and clammy. Low blood pressure. An abnormal heart rhythm or heart murmur they can hear through a stethoscope. […] Several tests can help you find out if you have cardiogenic shock. These include: Blood pressure cuff: To check for low blood pressure. Cardiac catheterization: This procedure helps your healthcare provider find blockages in the arteries that supply blood to your heart (coronary arteries). Your provider can also use a catheterization to check the amount of blood your heart is pumping with each beat (cardiac output). A long, thin tube called a catheter is inserted in an artery through a small puncture, usually in your wrist or groin. Electrocardiogram (ECG/EKG): A recording of your hearts electrical activity (heart rhythm). Echocardiogram: An ultrasound of your heart that allows your healthcare provider to determine the strength of your heart and look for any structural abnormalities such as problems with the valves. Chest X-ray: To look for fluid in your lungs and get pictures of your heart and blood vessels. Blood tests: To check the oxygen level in your blood and check for damage to major organs, such as your kidneys, heart and liver. Theyll also look at your electrolyte level.

• #8 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Cardiogenic-Shock-Diagnosis.aspx

  Cardiogenic shock is a medical emergency that needs to be treated before irreversible damage is caused to the vital organs such as the brain, lungs and kidneys. Diagnosing cardiogenic shock involves checking the patient for signs and symptoms of shock as well as performing tests to find out what is causing the shock. […] An outline of how cardiogenic shock is diagnosed is given below: […] The patients symptoms and medical history are checked including the details of any myocardial infarction or heart attack. Other causes of shock that are checked for include blood loss, hypovolemia (low blood volume), sepsis (blood infection), pulmonary embolism, tamponade, aortic dissection, and pre-existing valvular disease. […] On clinical examination, the patient is often an ashen or bluish colour, a condition called cyanosis caused by low oxygenation of tissues near the skin surface. The pulse may also be rapid, irregular or faint and the breathing fast and shallow. The jugular veins in the neck may be distended and chest examination by stethoscope may reveal a systolic murmur or ventricular septal defect.

• #9 Diagnosing Cardiogenic Shock in the ED – emDocs

  https://www.emdocs.net/diagnosing-cardiogenic-shock-in-the-ed/

  Classically, patients with CS present with complaints of dyspnea, chest pain, fatigue, and/or ankle swelling. Physical exam may reveal signs of congestion including peripheral edema, jugular venous distension (JVD), crackles/rales on auscultation, and signs of hypoperfusion such as cool, poorly perfused extremities. In a small retrospective review of 30 patients in undifferentiated shock, those with CS were more likely to have JVD (80% compared to 0% and 20%), cold skin (57.1% compared to 14.3% and. 28.5%), and pulmonary rales (75% vs 16.7% and 8.3%) compared to patients with distributive and hypovolemic shock, respectively. In another prospective study with 68 patients, residents used specific clinical exam findings to differentiate categories of shock. CS was categorized by SBP less than 90, signs of low output (cold hands, poor capillary refill, and weak pulse), elevated jugular venous pressure (JVP)> 7 cmH2O, S3 gallop, and crackles to 1/3 of the lungs. Of 68 patients, 11 met criteria for CS. In patients with echocardiographic evidence of low cardiac output, elevated JVP predicted CS with an accuracy of 80%, which was unchanged when adding the presence of crackles.

• #10 Diagnosing Cardiogenic Shock in the ED – emDocs

  https://www.emdocs.net/diagnosing-cardiogenic-shock-in-the-ed/

  Although JVP is a useful proxy for elevated wedge pressures, it may be difficult to assess due to body habitus and positioning of the patient (head of the bed should be elevated 45 degrees which can be difficult in patients with severe orthopnea). JVP is measured by calculating the highest pulsation point in cm above the sternal angle and then add 5 (as the right atrium is 5 cm below the sternal angle), which correlates to distension in cmH2O. Elevated values are often considered greater than 6-8 cmH2O. Of note, elevated JVP is associated with increased risk of mortality, with a relative risk (RR) of 1.52. […] Labs may show a metabolic acidosis (as lactate increases due to peripheral ischemia), renal hypoperfusion with resulting acute kidney injury, and possible evidence of cardiac ischemia with elevated troponin and EKG changes. In the CardShock study, a multicenter, prospective, observational study of 219 CS patients, lactate levels were significantly associated with increased mortality (adjusted odds ratio of 1.4). It is important to note that lactate elevation is not specific to sepsis and can be seen in any hypoperfused state such as CS.

• #11 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Cardiogenic-Shock-Diagnosis.aspx

  Electrocardiography is performed to detect heart function and rhythm problems. […] A chest X-ray may be performed to check for cardiomegaly (enlarged heart size), pulmonary venous congestion (increased blood vessel visibility within the lungs), or both. […] Arterial blood gas is measured to assess the blood levels of oxygen. […] Blood levels of electrolytes sodium, potassium and calcium are measured. […] Routine blood counts may be checked. […] Cardiac enzymes are measured as indicators of heart attack. B-type natriuretic protein (BNP) can help diagnose early heart disease as well as congenital heart disease and heart failure in children. […] Echocardiography is one of the best diagnostic methods for confirming the diagnosis of cardiogenic shock and ruling out causes of the condition. Echocardiography provides information about the general function of the heart and can help detect disorders such as papillary muscle rupture, acute mitral regurgitation, acute free-wall rupture, ventricular septal defect, and cardiac tamponade. […] A pulmonary artery catheter called the Swan-ganz catheter can be used to provide useful information on hemodynamics to assist in diagnosis.

• #12 Management of cardiogenic shock | EuroIntervention

  https://eurointervention.pcronline.com/article/management-of-cardiogenic-shock

  Although not specific to CS, arterial lactate has been shown to be strongly predictive of mortality. […] The CLIP score outperformed clinical CS scores and is objective without requirement for input of subjective parameters. […] Clinical and biological factors used for prognosis assessment have been summarised in multiple scores in the I) pre-shock, II) full CS, and III) venoarterial extracorporeal membrane oxygenation (VA-ECMO) settings previously. […] The SCAI shock classification validation is not always very objective because many variables were not available for score validation, leading to subjective classification. […] The target mean arterial pressure (MAP) is not well defined in CS. […] The optimal timing of initiation of MCS remains a matter of debate, and has often been left to the discretion of the operator in randomised trials. […] Overall, it appears that, as in non-CS STEMI, rapid diagnosis and initiation of treatment are critical, but formal RCT are required to clarify the findings to date, particularly for the case of Impella in light of the disparate data outlined above.

• #13 23. Cardiogenic Shock | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/23-cardiogenic-shock/23-cardiogenic-shock

  Cardiac dysfunction leading to insufficient cardiac output and tissue hypoperfusion. […] Consider when SBP 90 mmHg sustained for 30 min (or vasopressors required) AND clinical or objective signs of tissue hypoperfusion (see below). […] Note: consider the diagnosis of normotensive cardiogenic shock when normal BP but rising lactate and transaminitis. […] Clinical: altered mental status, cold/clammy skin or extremities, decreased urine output. […] Objective: lactate 2.0mmol/L, UOP 30mL/hr, CI 2.2 L/min*m2, renal failure, transaminase elevation. […] Clinical pearl: elevations in biliary labs generally suggest venous congestion while transaminase elevations generally suggest underperfusion from shock. […] The diagnosis of cardiogenic shock should be made with a low CI and high SVR.

• #14 Cardiogenic Shock: Past, Present, and Future Outlook | USC Journal

  https://www.uscjournal.com/articles/cardiogenic-shock-management-and-research-past-present-and-future-outlook?language_content_entity=en

  This classification was shown to correlate with both in-hospital mortality and mortality after hospital discharge. […] Ceglarek et al. published the results of a CULPRIT-SHOCK biomarker sub-study and presented a novel, fast, and objective, biomarker-based mortality risk score for patients with AMICS. […] Based on an evaluation of cystatin c, lactate, interleukin-6 and N-terminal pro-B-type natriuretic peptide, they established and validated the CLIP score as a mortality risk predictor.

• #14 Cardiogenic Shock: Past, Present, and Future Outlook | USC Journal

  https://www.uscjournal.com/articles/cardiogenic-shock-management-and-research-past-present-and-future-outlook?language_content_entity=en

  Although great strides have been made in the pathophysiological understanding, diagnosis and management of cardiogenic shock (CS), morbidity and mortality in patients presenting with the condition remain high. […] Therapeutic intervention is often time critical, not least to minimize secondary end-organ damage, so early diagnosis is key. […] Recently, Chioncel et al. again highlighted the significance of early detection of tissue hypoperfusion in patients with evolving or established CS. […] In this context, hypotension is no longer a required criterion, and the definition now includes normotensive CS. […] Baran et al. presented the Society for Cardiovascular Angiography and Interventions (SCAI) clinical expert consensus statement on the classification of cardiogenic shock, defining a grading system of CS ranging from stage A with patients At risk, through to B and C (Beginning and Classic CS) then to D and E (Deteriorating patients and those in Extremis).

• #15 Cardiogenic shock: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/cardiogenic-shock

  Cardiogenic shock is a medical emergency that requires immediate treatment. […] Doctors will work quickly to make a diagnosis based on the persons signs and symptoms while administering any treatments that they may need. […] The diagnostic process will include an electrocardiogram (EKG) that shows the activity of the heart. […] Research in the Journal of the American Heart Association notes that doctors should order the EKG within 10 minutes of the person presenting. […] Similarly, an echocardiogram can show an image of the heart to help doctors detect any areas of damage from a heart attack. […] Other diagnostic tools will help once the person is stable. […] The results of these tests may help confirm their diagnosis or change the course of treatment.

• #16 How To Document And Code Cardiogenic Shock | Cardiology Coding

  https://www.outsourcestrategies.com/blog/how-to-document-and-code-cardiogenic-shock/

  Regarded as a life-threatening condition, cardiogenic shock occurs when the heart is suddenly unable to supply enough blood to the vital organs of the body. […] Diagnosis of cardiogenic shock will begin with a complete physical examination wherein the level of pulse and blood pressure are checked. Additional tests include – Electrocardiogram (ECG or EKG), Echocardiogram, Cardiac catheterization (angiogram) and Chest X-ray. […] As per reports from the Journal of the American Heart Association, physicians need to perform the EKG (reveal irregularities in the heart rhythm) within 10 minutes of the person presenting. […] Even though there are no guaranteed screening tests for cardiogenic shock, identifying the root causes of symptoms is key to preventing this condition.

• #17 Cardiogenic Shock | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/cardiogenic-shock

  Often the diagnosis of cardiogenic shock is made by the emergency medical team in the ambulance or at the hospital. These are some of the tests they may use to determine whether you had a heart attack and if you have cardiogenic shock: […] Blood pressure measurements. Cardiogenic shock usually causes low blood pressure. […] Chest x-ray. The images provide information about your heart and blood vessels and can reveal whether there’s fluid in your lungs. […] Electrocardiogram (ECG). This test measures your heart’s electrical activity. […] Echocardiogram. This ultrasound of the heart can show blockages in the arteries and how your blood is flowing. […] Blood tests. Various blood tests can show whether your blood has too much carbon dioxide or too little oxygen (both signs of cardiogenic shock) and can check troponin levels, proteins that are released when the heart muscle is damaged. […] Cardiac catheterization. This procedure can be used to look for blocked areas in your arteries and to check the amount and pressure of the blood that your heart is pumping with each beat.

• #18 Cardiogenic shock – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cardiogenic-shock/diagnosis-treatment/drc-20366764

  Echocardiogram. Sound waves produce an image of your heart. This test can help identify damage from a heart attack. […] Cardiac catheterization (angiogram). This test can reveal blocked or narrowed arteries. A doctor inserts a long, thin tube (catheter) through an artery in your leg or wrist and guides it to your heart. Dye flows through the catheter, making your arteries more easily seen on X-ray.

• #19 Cardiogenic Shock

  https://www.csh.org.tw/dr.tcj/educartion/f/web/Cardiogenic%20Shock/index.htm

  Cardiogenic shock is diagnosed after documentation of myocardial dysfunction and exclusion of alternative causes of hypotension, such as hypovolemia, hemorrhage, sepsis, pulmonary embolism, pericardial tamponade, aortic dissection, and preexisting valvular disease. Shock is present if evidence of multisystem organ hypoperfusion is detected on physical examination. […] The hemodynamic measurements of cardiogenic shock are a pulmonary capillary wedge pressure (PCWP) greater than 15 mm Hg and a cardiac index of less than 2.2 L/min/m2. […] Echocardiography should be performed early to establish the cause of cardiogenic shock. […] The presence of large V waves on the pulmonary capillary wedge pressure tracing suggests severe mitral regurgitation. […] A step-up in oxygen saturation between the right atrium and the RV is diagnostic of ventricular septal rupture. […] Coronary angiography is urgently indicated in patients with myocardial ischemia or MI who also develop cardiogenic shock. Angiography is required to assess the anatomy of the coronary arteries and the need for urgent revascularization.

• #20 Management of cardiogenic shock: a narrative review | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01260-y

  Cardiogenic shock (CS) is characterized by low cardiac output and sustained tissue hypoperfusion that may result in end-organ dysfunction and death. […] Timely diagnosis and multidisciplinary team-based management have demonstrated favourable effects on outcomes. […] The approach to manage CS patients should be multimodal. It includes assessment of severity and early determination of the etiology with clinical examination and non-invasive exploration (clinical ECG, biological and echocardiographic tests). Transthoracic echocardiography (TTE) is the most useful diagnostic modality in this setting, due to its ability to provide comprehensive information about cardiac structure and function, promptly, safely, and at the patients bedside. […] Moreover, early comprehensive TTE can provide important prognostic insights in CS patients.

• #21 Diagnosing Cardiogenic Shock in the ED – emDocs

  https://www.emdocs.net/diagnosing-cardiogenic-shock-in-the-ed/

  When patients present to the ED hypotensive or hypoperfused, the RUSH exam is a quick way to differentiate shock by looking at the “the pump, the tank, and the pipes.” For CS, transthoracic echocardiogram classically demonstrates a hypodynamic, dilated LV, with poor LV squeeze and associated inadequate motion of the anterior leaflet of the mitral valve during systole and diastole (i.e. poor contractility). Estimation of ejection fraction (EF) and CO (as CO=stroke volume (SV) x heart rate (HR)) through simply “eyeballing” LV squeeze is an adequate assessment by physicians in the acute setting. In CS, the inferior vena cava (IVC), which is an indirect measurement of effective intravascular volume, should have a diameter of >2 cm diameter and collapses less than 50% with inspiration. These findings correlate with an elevated central venous pressure. However, the IVC assessment may be inaccurate if the patient has already received vasodilators, diuretics, and/or is ventilated. Thoracic windows are likely to show pulmonary edema in the form of excessive B lines (“lung rockets”) which are the result of septal thickening from water accumulation in the interstitium. Along with pulmonary congestion, there may be pleural and peritoneal fluid on RUSH exam. In a meta-analysis that used data from three original papers and two case reports, the RUSH protocol was shown to be both sensitive and specific (0.89 and 0.97, respectively) in the diagnosis of CS. Despite a high resulting positive likelihood ratio (LR) of 22.29, there was only a moderate negative LR of 0.17, suggesting the RUSH exam is not the perfect test to rule out CS. Therefore, the RUSH exam should be used in the context of a careful history and physical exam rather than used alone to diagnose cardiogenic shock.

• #22 Cardiogenic Shock Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/152191-workup

  Echocardiography should be performed early to establish the cause of cardiogenic shock. […] Coronary angiography is urgently indicated in patients with myocardial ischemia or MI who also develop cardiogenic shock. […] Invasive hemodynamic monitoring (Swan-Ganz catheterization) is very useful for helping to exclude other causes and types of shock (eg, volume depletion, obstructive shock, and septic shock). […] The hemodynamic measurements of cardiogenic shock are a pulmonary capillary wedge pressure (PCWP) higher than 15 mm Hg and a cardiac index lower than 2.2 L/min/m2.

• #23 Cardiogenic Shock Diagnosis | Temple Health

  https://www.templehealth.org/services/conditions/cardiogenic-shock/diagnosis

  Blood tests are used to determine if there is too much carbon dioxide or not enough oxygen in the blood indicators of shock. Blood tests also used to measure for certain enzymes that indicate kidney or liver damage, while high levels of certain heart muscle biochemicals (eg, CK, CK-MB, troponin, serum myoglobin) suggest a heart attack. […] Echocardiogram is a non-invasive test using ultrasound (sound waves) and a device called a transducer which is placed on the surface of the chest (ultrasound) to create a moving picture of the heart. It shows the size and shape of the heart chambers, and reveals problems with pumping function perhaps due to a heart attack. […] Left heart catheterization uses a catheter (long thin flexible tube) that is inserted through an artery in the leg, arm, or neck and guided to either the coronary artery to check for blockages, or to the inside of the heart to measure volume or pressure, or to take pictures of heart walls or valves.

• #24 Cardiogenic Shock: Diagnosis – Cardio Guide

  https://www.cardioguide.ca/cardiogenic-shock-diagnosis-2/

  Your assessment should place a patient with CS into one of the 4 categories. […] Swan-Ganz catheter used to objectively measure hemodynamic parameters, which can be used to: Confirm diagnosis of CS, Determine hemodynamic response and guide titration of supportive medical therapy, Risk stratify CS patients and determine eligibility and type of advanced heart failure therapy. […] There is no one way or cookie-cutter approach to managing cardiogenic shock. […] Important considerations include Isolated right ventricular dysfunction, Isolated left ventricular dysfunction, biventricular failure, pulmonary hypertension, etiology of shock, arrhythmias, valvular disease, these factors drastically effect how cardiogenic shock is managed including therapeutic options that can be provided to patients.

• #24 Cardiogenic Shock: Diagnosis – Cardio Guide

  https://www.cardioguide.ca/cardiogenic-shock-diagnosis-2/

  Laboratory Markers of Malperfusion: Elevated Lactate, Elevated Liver Enzymes (liver congestion/malperfusion), Elevated Troponin (reduced coronary perfusion), Elevated CK (poor muscle perfusion), Reduced Central Venous Oxygenation (CvO2) 70% (increased O2 extraction by tissues). […] Invasive hemodynamics: Reduced Cardiac Output (CO) ~4 L/min (Cardiac Index (CI) 2.2 L/min/m^2), High systemic vascular resistance (SVR). […] Identify Causes of CS: Physical Exam: New murmur? (Acute MR/AR), Arrhythmias, Signs of tamponade (muffled sounds, pulsus paradoxus). […] An urgent echocardiogram is indicated since it identifies most causes and can reveal urgent treatment options. […] If the patient is congested, preload must be cautiously lowered to reduce congestion and improve oxygenation, while minimizing the reduction in stroke volume.

• #25 Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-024-00770-y

  Echocardiography is a noninvasive diagnostic modality, which can be performed at the bedside. […] Echocardiography offers a viable screening tool for high-risk patients for SICS. […] While a previous meta-analysis has not confirmed the overall advantage of pulmonary artery catheter (PAC) in critically ill patients, many studies included in this meta-analysis did not specifically address the use of PAC in cardiogenic shock. […] Our recent study indicated that patients with SICS might benefit from early invasive hemodynamic monitoring with PAC. […] Therefore, the use of PAC needs to be early enough to meaningfully change management. […] Effective management of SICS requires accurate volume assessments, adequate selection of vasoactive and inotropic agents, and their goal-directed titration, all of which can be guided by PAC.

• #26 Sepsis-induced cardiogenic shock: controversies and evidence gaps in diagnosis and management | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-024-00770-y

  A new-onset reduction in LV ejection fraction to less than 50%, or a decrease of more than 10% from baseline during sepsis has been used in previous retrospective studies to define sepsis-induced cardiomyopathy. […] However, there is currently no consensus on the diagnostic criteria for this condition. […] While the diagnostic criteria for SICS remain undefined, it may be reasonable to apply similar criteria used for cardiogenic shock given that this definition is widely accepted. […] Cardiogenic shock is generally defined as a state of end-organ hypoperfusion resulting from cardiac dysfunction. […] Several definitions of cardiogenic shock have been proposed, but the diagnostic criteria typically include persistent hypoperfusion along with a severely reduced cardiac index. […] The National Cardiogenic Shock initiative recommends calculating Cardiac Power Output (CPO) and Pulmonary Artery Pulsatility Index (PAPI) for prognostication and treatment guidance during cardiogenic shock.

• #27 Cardiogenic Shock – Part 1: Early Diagnosis

  https://www.fizzicu.com/post/cardiogenic-shock-part-1-early-diagnosis

  This definition should improve the ability to diagnose cardiogenic shock. If you see someone with decreased cardiac function and high filling pressures on echo it should lead someone to cardiogenic shock, but often people with still default to saying they have heart failure but are in septic shock. […] The SHOCK trial also included hemodynamic compromise: cardiac index 2.2 L/min, pulmonary artery occlusion pressure (PAOP) 15 mmHg. This is a standard definition and is used most often for cardiogenic shock. […] Another reason hemodynamic measurements are important is that it can be used to predict mortality. Clinical decision parameters and hemodynamic measurements were evaluated for mortality predictors in cardiogenic shock. Cardiac power was shown to be the strongest correlate to mortality in cardiogenic shock.

• #28 Diagnosis | SCAI – Seconds Count

  https://www.secondscount.org/condition/cardiogenic-shock/diagnosis

  If you suspect youre in cardiogenic shock (CS), you must act quickly and seek immediate medical attention, as CS often leads to death without prompt diagnosis and treatment. For doctors to confirm a diagnosis of CS, they will conduct a physical exam and a series of diagnostic tests. […] Once youre in a doctors care, your doctor will first obtain your medical history, including any symptoms youre currently having and any medications youre taking, and perform a physical exam, which may reveal the following signs of CS: […] In addition, your doctor will conduct several tests to confirm a CS diagnosis, which may include the following: […] Once youve been diagnosed with CS, your doctor will also classify the severity of your CS based on the following classification system developed by SCAI.

• #29 Cardiogenic Shock | RECAPEM

  https://recapem.com/cardiogenic-shock/

  Elevated left atrial pressure reflects the wet (pulmonary edema) feature of cardiogenic shock. […] Elevated right-sided filling pressure may reflect volume overload. […] Patients with chronic heart failure often have systemic congestion. […] The SCAI classification establishes a unifying system for grading the severity of CS. […] Patients with acute cardiovascular disease are stratified into 5 SCAI shock stages of escalating severity. […] The distinction between SCAI SHOCK stages B and C is critical. […] Patients with hypoperfusion in the absence of hypotension (normotensive CS; classified as stage C in SCAI) are at higher risk of dying than patients with hypotension and preserved perfusion (hypotensive normoperfusion; classified as stage B in SCAI). […] The SCAI classification is validated in a large cohort of unselected intensive cardiac care unit (ICCU) patients providing robust mortality risk stratification regardless of CS etiology.

• #30 Early Recognition and Risk Stratification in Cardiogenic Shock: Well Begun Is Half Done

  https://www.mdpi.com/2077-0383/12/7/2643

  Clearly defined criteria are usually the mainstay of early recognition in clinical medicine. […] The latest guidelines of the European Society of Cardiology (ESC) for the diagnosis and treatment of acute and chronic heart failure focus on the presence of hypoperfusion based on clinical signs and on addition laboratory parameters. […] Recent studies highlight the importance of identifying CS in the initial stages, given the increased mortality of patients with hypoperfusion in the absence of hypotension, compared to patients with isolated hypotension. […] The principal limitation regarding the aforementioned criteria is that CS is approached as a binary condition. […] The SCAI proposed a shock severity classification which covered the relevant practical gap in the formerly used CS criteria and bedside clinical assessment.

• #31 Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome

  https://www.imrpress.com/journal/RCM/22/3/10.31083/j.rcm2203078/htm

  The clinical practices in CS management remain inconsistent. Herein, this review discusses the current evidence in the diagnosis and management of CS complicating ACS, and features the changes in CS definition and classification. […] The diagnosis of CS is usually differentiated from other types of shock (i.e., distributive, hypovolemic, non-obstructive) based on history, physical examination, laboratory data, and electrocardiogram characteristics. As any condition leading to profound LV or RV impairment can result in CS, various causes should be identified such as acute MI, acute decompensated heart failure, post-cardiotomy shock, atrial or ventricular arrhythmias, or valvular diseases. CS diagnosis should also distinguish between CS and mixed shock type due to other contributing factors, such as infection, bowel ischemia, or hemorrhage in the setting of MI.

• #32 Cardiogenic shock differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Cardiogenic_shock_differential_diagnosis

  Shock is a clinical syndrome resulting from the hypoperfusion of the tissues. […] Cardiogenic shock is a clinical condition, defined as a state of systemic hypoperfusion originated in cardiac failure, in the presence of adequate intravascular volume, typically followed by hypotension, which leads to insufficient ability to meet oxygen and nutrient demands of organs and other peripheral tissues. […] Patients who present with signs and symptoms of hypoperfusion following a diagnosed or suspected myocardial infarction, are commonly suffering a cardiogenic shock as a complication of the MI. […] When comparing hypovolemic and cardiogenic shock (most commonly complicating acute-MI) some specific clinical signs of shock will be similar, however, others will be different, particularly signs of CHF, such as the presence of distended jugular and peripheral veins, presence of an S3 sound and pulmonary edema on the cardiogenic type.

• #33 Cardiogenic shock differential diagnosis – wikidoc

  https://www.wikidoc.org/index.php/Cardiogenic_shock_differential_diagnosis

  When treating hypovolemic shock it’s mandatory to rule out cardiogenic cause because part of the treatment for hypovolemic shock, urgent intravascular volume replacement, may further jeopardize the cardiac condition in the cardiogenic form. […] To evaluate the hemodynamics of obstructive shock it is important to know the underlying etiology of the shock, since different causes will present with different hemodynamic values. One example of cause of obstructive shock is cardiac tamponade, which, similarly to the cardiogenic form, will likely present with: decreased cardiac index, stroke volume, stroke work, mixed venous oxygen saturation and increased difference in arteriovenous O2 saturation, right and left ventricular diastolic pressures, pulmonary artery diastolic pressure, serum lactate and CVP. […] When compared to cardiogenic shock it presents with similarities, such as: decreased cardiac index, left and right ventricular stroke work and increased serum lactate.

• #34 Shock – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/shock/

  Shock is a life-threatening circulatory disorder that leads to tissue hypoxia and a disturbance in microcirculation. […] Cardiogenic shock is characterized by cardiac ischemia, arrhythmias, valvulopathy, and cardiotoxic substance exposure. […] Diagnosis is mostly clinical but measurement of functional parameters (e.g., PCWP, cardiac output, SVR) can help distinguish between the different types of shock. […] Signs of congestive heart failure alongside shock (e.g., JVP, crackles on lung auscultation) are suggestive of cardiogenic shock. […] Shock is a clinical diagnosis. […] In all patients with shock, immediately measure ABGs, lactate levels, capillary glucose, perform an ECG, and order a chest x-ray and general laboratory studies. […] Cardiogenic shock is most commonly caused by myocardial infarction.

• #35 Shock – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/shock

  Shock is a life-threatening circulatory disorder that leads to tissue hypoxia and a disturbance in microcirculation. […] Cardiogenic shock is characterized by cardiac ischemia, arrhythmias, valvulopathy, and cardiotoxic substance exposure. […] Diagnosis is mostly clinical but measurement of functional parameters (e.g., PCWP, cardiac output, SVR) can help distinguish between the different types of shock. […] Signs of congestive heart failure alongside shock (e.g., JVP, crackles on lung auscultation) are suggestive of cardiogenic shock. […] Shock is a clinical diagnosis. […] Routine investigations can help identify the shock subtype but are not required for diagnosis. […] In all patients with shock, immediately measure ABGs, lactate levels, capillary glucose, perform an ECG, and order a chest x-ray and general laboratory studies.

• #36 Management of cardiogenic shock: a narrative review | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01260-y

  The cornerstone of treatment that improved CS prognosis in AMI patients is emergent coronary revascularization (or Percutaneous Coronary Intervention PCI) in patients with coronary artery disease. […] The benefit of an initial revascularization strategy was confirmed in a nationwide cohort study including 60,833 patients, showing a significant reduction in mortality compared with a conservative strategy. […] The management of CS has seen significant advances in recent decades, but the mortality remains dramatically high. […] Rapid recognition with multimodal evaluation by ECG, biological and echocardiographic tests allows early and appropriate management and may improve survival.

• #37 Cardiogenic Shock – Part 1: Early Diagnosis

  https://www.fizzicu.com/post/cardiogenic-shock-part-1-early-diagnosis

  It is recommended that all patients with suspected cardiogenic shock receive imaging. […] Early identification and early intervention of cardiogenic shock have shown the best outcomes. […] The main point to take away from this is that we as clinicians are not good at determining adequate cardiac output at the bedside with a success rate of 50%, or a coin flip. Additionally, the speed of diagnosing the type of shock is just as important as the accuracy of diagnosing the type of shock. If a patient presents with cardiogenic shock to the hospital their mortality can be 50% or be reduced to 20% by having a good algorithm and system in place to help with a quick accurate diagnosis.

• #38 The Contemporary Cardiogenic Shock ‘Playbook’ | USC Journal

  https://www.uscjournal.com/articles/contemporary-cardiogenic-shock-playbook?language_content_entity=en

  Patients in CS often deteriorate rapidly, and as shock persists, end-organ hypoperfusion, ischemia, and acidosis worsen, often irreversibly. Successful diagnostic and therapeutic decision-making must, therefore, be both timely and rapidly effective. Use of newer advanced therapies and various forms of mechanical circulatory support often require the coordinated efforts of multiple medical specialists to include interventional cardiologists, cardiothoracic surgeons, advanced heart failure specialists, and cardiac intensivists. […] […] Multidisciplinary team-based, protocol-driven CS care has demonstrated promising potential to improve clinical outcomes beyond the historical 50% glass ceiling of the past three decades. Despite recent consensus efforts to standardize definitions, the complex hemodynamics and variable clinical phenotypes of the CS syndrome mean that the diagnosis and management of CS remains challenging, and often requires expertise across a range of medical specialties. […]

• #39 Cardiogenic Shock Team Cuts Time to Diagnosis by Half – AACN

  https://www.aacn.org/newsroom/cardiogenic-shock-team-cuts-time-to-diagnosis-by-half

  A cardiovascular specialty hospital in north Texas decreased time to diagnosis for patients with cardiogenic shock by more than half, according to a study published in Critical Care Nurse (CCN). […] Improving Cardiogenic Shock Team Activation Through Nurse Education and Alert Implementation details how a nurse-led quality improvement initiative at the hospital significantly improved the time from first signs to diagnosis for patients already admitted and the time from the initial transfer request to acceptance for patients being transferred from a referring hospital. […] The mean time to diagnosis decreased significantly, from nearly 18 hours to 8.15 hours. For patients with cardiogenic shock transferring from a referring hospital, the median time to acceptance fell from 1.55 hours to 0.35 hour.

• #40 ‘Combat’ Approach to Cardiogenic Shock | ICR Journal

  https://www.icrjournal.com/articles/combat-approach-cardiogenic-shock?language_content_entity=en

  Since initiating our INOVA cardiogenic shock programme in January 2017, there have been 161 team activations for AMI CS, ADHF CS and suspected or undifferentiated CS. […] A consensus plan of care based on our protocol and established care priorities is developed and tailored to the specific clinical scenario. […] Our initiatives to date have resulted in progressively improving outcomes for AMI CS and ADHF CS with in an increase in all-comer survival rates at our institution from 47 % (n=110) in 2016, to 61 % (n=140) in 2017, and 81 % (n=21) in the first 2 months of 2018. […] These data support our hypothesis that team-based multidisciplinary care, haemodynamic guidance and early consideration of MCS improve survival in patients with AMI or ADHF CS. […] Although hampered by small sample sizes and lack of long-term outcomes data, current registries and single-centre reports, to include our own preliminary experience to date, suggest that team-based multidisciplinary care, early initiation of MCS, and haemodynamic-guided therapy may form the next leap forward in CS care to interrupt the vicious triad of ischaemia, hypotension and myocardial dysfunction and allow for myocardial salvage and meaningful patient recovery.

• #41 Diagnosing Cardiogenic Shock in the ED – emDocs

  https://www.emdocs.net/diagnosing-cardiogenic-shock-in-the-ed/

  As discussed above, there is not a single exam finding or lab test that can diagnose CS. Therefore, when there is a high suspicion of CS in the setting of hypotension or signs of hypoperfusion, we suggest using history, a detailed physical exam, bedside US, labs (specifically creatinine, lactate, troponin, BNP and other markers of hypoperfusion/end-organ-damage), and EKG (as acute MI is the primary cause of CS and signs of ischemia and may require emergent revascularization) to aid in diagnosis. Consider an arterial catheter monitor to BP and guide treatment. Beyond a focused cardiac and pulmonary examination, physical exam should focus on JVD and extremity perfusion. The RUSH exam and calculation of EF/CO/CI through LVOT VTI measurements discussed above are valuable adjuncts to the evaluation. Using a comprehensive approach to evaluate for CS will create a better understanding of this heterogeneous disease and help guide management.

• #42 Cardiogenic Shock | RECAPEM

  https://recapem.com/cardiogenic-shock/

  Tachycardia (a PR 100 bpm). Generally, both pulmonary edema and systemic hypoperfusion are hyperadrenergic states. […] Marked bradycardia (e.g. HR40) should always raise concern for shock even in normotensive patients. […] Shock Index 0.8 can suggest hemodynamic instability. […] Arterial lactate 2mmol/L. Lactate elevation is not very sensitive for diagnosis of shock. […] There is no sign, symptom, or lab test that is entirely sensitive or specific for shock. […] The clinical presentation of shock is not uniform. Shock is a physiologic continuum that can progress through several stages with different clinical presentations. […] The core feature of CS is ineffective cardiac output. […] The presence of a hyperdynamic heart will rule out CS. […] A low CI (e.g. 2.2 L/min/m2) is the key finding in CS with different hemodynamic phenotypes.

• #43 Early Recognition and Risk Stratification in Cardiogenic Shock: Well Begun Is Half Done

  https://www.mdpi.com/2077-0383/12/7/2643

  Several observational studies have validated the SCAI SHOCK classification in various populations and clinical settings. […] CS management mandates a short timeframe, widely referred to as the “golden hour”. […] An initial systematic Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach ensures prompt and holistic evaluation of patients with suspected CS. […] The main goals in the primary investigation are the identification of signs of hemodynamic compromise and the assessment of end-organ perfusion and volume status. […] The prompt comprehensive diagnostic approach facilitates the identification of the CS cause. […] Identifying the underlying cause early is critical, as the patient’s subsequent management should be targeted and can be significantly different depending on etiology.

• #44 Management of cardiogenic shock: a narrative review | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01260-y

  Current guidelines emphasize the initiation of early (within the first few hours) basic monitoring that should be supplemented by advanced monitoring in more complicated cases and in refractory shock. […] Elevated lactate level is associated with an increased risk of mortality. […] TTE is one of the most useful basic monitoring modality in CS patients, due to its accuracy to determine CO and CI with good correlation with pulmonary artery catheters (PAC) data. […] In addition to this standard/basic monitoring, parameters derived from central venous catheter (in the superior vena cava territory) may be also helpful in severe patients: the central venous oxygen saturation (ScvO2), which reflects balance between supply and consumption, and the veno-arterial difference in CO2 tension. […] An increasing number of studies report the use of PAC and its association with CS prognosis improvement.

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