Materiały źródłowe

• #1 Cardiogenic shock – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cardiogenic-shock/symptoms-causes/syc-20366739

  Cardiogenic shock is a life-threatening condition in which your heart suddenly can’t pump enough blood to meet your body’s needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock. […] In most cases, a lack of oxygen to your heart, usually from a heart attack, damages its main pumping chamber (left ventricle). Without oxygen-rich blood flowing to that area of your heart, the heart muscle can weaken and go into cardiogenic shock. […] Rarely, damage to your heart’s right ventricle, which sends blood to your lungs to get oxygen, leads to cardiogenic shock. […] Other possible causes of cardiogenic shock include: Inflammation of the heart muscle (myocarditis), Infection of the heart valves (endocarditis), Weakened heart from any cause, Drug overdoses or poisoning with substances that can affect your heart’s pumping ability.

• #2 Cardiogenic Shock – Causes and Risk Factors | NHLBI, NIH

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

  A heart attack is the most common cause of cardiogenic shock. Less often, another heart problem or a problem somewhere else in the body blocks blood flow coming into or out of the heart and leads to cardiogenic shock. […] Cardiogenic shock usually develops very quickly when it follows a heart attack. Other heart conditions, such as heart failure or arrhythmia, can make it harder for the heart to deliver oxygen-rich blood to the organs, leading to cardiogenic shock. […] Cardiogenic shock can be caused by problems outside the heart, including fluid buildup in the chest, internal bleeding or blood loss, or pulmonary embolism, which occurs when a blood clot gets stuck in an artery of the lung. […] Rarely, some medicines can cause cardiogenic shock if you take a dose that is too high, or if your heart is not working well after a heart attack or other heart problem. […] The main cause of cardiogenic shock is a heart attack, which is a complication of coronary heart disease. […] Certain factors may increase your risk for cardiogenic shock. […] Cardiogenic shock may be more common in women than men.

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

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

  Cardiogenic shock is a life-limiting condition that happens suddenly when your heart cant pump enough blood to keep up with your bodys demand for it. A heart attack is the most common cause of cardiogenic shock. […] Cardiogenic shock is most often caused by a heart attack or heart failure. […] A heart attack is the most common cause of cardiogenic shock. A severe heart attack can damage your hearts main pumping chamber (left ventricle). When this happens, your body cant get enough oxygen-rich blood. […] Other conditions that make your heart weak and can lead to cardiogenic shock include: Damaged heart muscle from having a heart attack. Inflammation of your heart muscle (myocarditis). An infection of your hearts inner lining and valves (endocarditis). An abnormal heart rhythm (arrhythmia). Too much fluid or blood around your heart (cardiac tamponade). A blood clot that suddenly blocks a blood vessel in your lung (pulmonary embolism). A heart valve problem, such as torn muscles supporting your valve or an artificial valve not working right. Damage to the septum that divides the left and right ventricles of your heart. Heart failure. Injury to your chest.

• #4 Cardiogenic Shock – StatPearls – NCBI Bookshelf

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

  Cardiogenic shock is a primary cardiac disorder characterized by a low cardiac output state of circulatory failure that results in end-organ hypoperfusion and tissue hypoxia. […] The most common cause of cardiogenic shock is acute myocardial infarction, though other disorders leading to impairment of the myocardium, valves, conduction system, or pericardium also can result in cardiogenic shock. […] Various forms of cardiac dysfunction can cause cardiogenic shock. […] The most common causes of cardiogenic shock include: Acute myocardial ischemia, Mechanical defect: acute mitral regurgitation (papillary muscle rupture), ventricular wall rupture (septal or free wall), cardiac tamponade, left ventricular outflow obstruction (hypertrophic obstructive cardiomyopathy [HOCM], aortic stenosis [AS]), Left ventricular inflow obstruction (MS, atrial myxoma), Contractility defect: ischemic and non-ischemic cardiomyopathy, arrhythmias, septic shock with myocardial depression, myocarditis, Pulmonary embolus (right ventricular with or without left ventricular failure), Right ventricular failure, Aortic dissection, Other causes include cardiotoxic drugs (doxorubicin), medication overdose (beta/calcium channel blockers), metabolic derangements (acidosis), electrolyte abnormalities (calcium or phosphate).

• #5

  https://journals.lww.com/co-criticalcare/fulltext/2021/08000/epidemiology_and_causes_of_cardiogenic_shock.12.aspx

  Cardiogenic shock is a complex clinical syndrome of end-organ hypoperfusion due to impaired cardiac performance. Although cardiogenic shock has traditionally been viewed as a monolithic disorder predominantly caused by severe left ventricular dysfunction complicating acute myocardial infarction (AMI), there is increasing recognition of the diverse causes of cardiogenic shock and wide spectrum of clinical severity. […] The proportion of cardiogenic shock cases related to AMI has decreased over time to 30%, while the proportion of cardiogenic shock cases due to acute decompensated heart failure has steadily increased.

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

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

  Cardiogenic shock (CS) represents a life-threatening condition equated to a dismal prognosis. Since the introduction of the fundamental mechanisms of shock in 1972, CS has been universally defined as a state of severe end-organ hypoperfusion and tissue hypoxia resulting primarily from cardiac pump failure. Epidemiological data over the last decade report a significant increase in the incidence rate of hospitalizations, while in-hospital mortality has not shown any significant improvement. Traditionally, acute coronary syndrome (ACS) has been the leading cause of CS, accounting for approximately 80% of cases. However, recent observational studies report a declining incidence of ACS-CS, ranging from 30 to 55.4%, with a concurrent increase in the incidence of CS of other etiologies, mainly decompensated heart failure (AHF-CS).

• #7 Cardiogenic Shock: Causes, Symptoms, Treatment | Doctor

  https://patient.info/doctor/cardiogenic-shock

  Cardiogenic shock most commonly occurs as a complication of acute myocardial infarction (MI). It occurs in 7% of patients with ST-segment elevation MI and 3% with non ST-segment elevation MI. […] Cardiogenic shock is most often caused by acute MI, particularly affecting the anterior wall of the heart. […] Due to an intrinsic heart problem: MI. Myocardial contusion (often from steering wheel impact). Acute dysrhythmia compromising cardiac output. Acute mitral regurgitation (usually as a complication of MI due to ruptured chordae tendinae). Ventricular septal rupture (usually occurring as post-MI complication). Cardiac rupture (rupture of the wall of the left ventricle can occur post-MI or due to cardiac trauma). Hypertrophic obstructive cardiomyopathy or end-stage cardiomyopathy of other cause. Myocarditis. Post-cardiac surgery requiring prolonged cardioplegia and cardiopulmonary bypass. Severe valvular heart disease, particularly aortic stenosis.

• #8 Cardiogenic Shock: Emergency Department-Focused Management – emDocs

  https://www.emdocs.net/cardiogenic-shock-emergency-department-focused-management/

  It may be helpful to categorize etiologies of CS by their underlying cause (e.g. Structure, Squeeze, and Stoppage). […] The first step in treating CS is recognizing it. A good first step in evaluating for undifferentiated shock in the emergency department is the Rapid Ultrasound for Shock and Hypotension (RUSH) exam. […] The goal of ED treatment in VSR is the reduction of afterload to decrease the left-to-right shunt. […] The pathophysiology of sepsis-induced CS is not completely understood, but it presents with some or (often) all of the following: LV dysfunction, RV dysfunction, and dilation of both ventricles. […] Sepsis-induced CS is often defined by its acute nature, absence of acute coronary syndrome (ACS), and reversibility after the primary insult is resolved. […] AMI is the primary cause for 70% of all cases of CS. CS is more likely to result from ST-elevation myocardial infarction (STEMI) than non-STEMI (NSTEMI). […] For patients with confirmed AMI causing CS, definitive care is reperfusion therapy.

• #9 Cardiogenic Shock: Practice Essentials, Background, Pathophysiology

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

  Cardiogenic shock can result from the following types of cardiac dysfunction: Systolic dysfunction, Diastolic dysfunction, Valvular dysfunction, Cardiac arrhythmias, Coronary artery disease, Mechanical complications. […] The vast majority of cases of cardiogenic shock in adults are due to acute myocardial ischemia. Indeed, cardiogenic shock is generally associated with the loss of more than 40% of the LV myocardium, although in patients with previously compromised LV function, even a small infarction may precipitate shock. […] Complications of acute MI, such as acute mitral regurgitation, large RV infarction, rupture of the interventricular septum or LV free wall, and tamponade can result in cardiogenic shock. […] Many cases of cardiogenic shock occurring after acute coronary syndromes may be due to medication administration. The use of beta blockers and angiotensin-converting enzyme (ACE) inhibitors in acute coronary syndromes must be carefully timed and monitored.

• #10 Cardiogenic Shock | Diseases and Disorders

  https://nursing.unboundmedicine.com/nursingcentral/view/Diseases-and-Disorders/73546/all/Cardiogenic_Shock

  Cardiogenic shock occurs when cardiac output is insufficient to meet the metabolic demands of the body, resulting in inadequate tissue perfusion. […] The most common cause of cardiogenic shock is acute myocardial infarction (MI) resulting in a loss of more than 40% of the functional myocardium. Cardiogenic shock occurs with 5% to 10% of all hospital admissions for acute MI. Other causes include papillary muscle rupture, left ventricular free wall rupture, acute ventricular septal defect, severe congestive heart failure, end-stage cardiomyopathy, severe valvular dysfunction, acute cardiac tamponade, cardiac contusion, massive pulmonary embolus, or overdose of drugs such as beta blockers or calcium channel blockers.

• #11 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 arises from an imbalance between input and demand, causing systemic hypoperfusion and organ dysfunction. […] Distinguishing between acute CS and acute-on-chronic CS is essential because mortality is higher in acute CS. […] In acute CS, there is a sudden reduction in ventricular contractility, leading to decreases in stroke volume, CO and blood pressure and increases in pulmonary capillary wedge pressure and central venous pressure. […] Chronic heart failure progresses to CS when impaired ventricular contractility is severe enough to cause a critical reduction in cardiac output (CO). […] Most epidemiological data on shock in critically ill patients focus on severe sepsis and septic shock, which are thought to be the leading causes of mortality in these patients. […] Although less frequent, cardiogenic shock (CS) remains a genuine clinical challenge with similar or even higher mortality rates.

• #12 Cardiogenic shock Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/cardiogenic-shock

  Cardiogenic shock takes place when the heart is unable to supply enough blood and oxygen to the organs of the body. […] The most common causes of cardiogenic shock are serious heart conditions. Many of these occur during or after a heart attack (myocardial infarction). These complications include: A large section of heart muscle that no longer moves well or does not move at all, Breaking open (rupture) of the heart muscle due to damage from the heart attack, Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia, Pressure on the heart due to a buildup of fluid around it (pericardial tamponade), Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve, Tear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers), Very slow heart rhythm (bradycardia) or problem with the electrical system of the heart (heart block).

• #13 Cardiogenic Shock: Practice Essentials, Background, Pathophysiology

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

  Cardiogenic shock can result from the following types of cardiac dysfunction: Systolic dysfunction, Diastolic dysfunction, Valvular dysfunction, Cardiac arrhythmias, Coronary artery disease, Mechanical complications. […] The vast majority of cases of cardiogenic shock in adults are due to acute myocardial ischemia. Indeed, cardiogenic shock is generally associated with the loss of more than 40% of the LV myocardium, although in patients with previously compromised LV function, even a small infarction may precipitate shock. […] Complications of acute MI, such as acute mitral regurgitation, large RV infarction, rupture of the interventricular septum or LV free wall, and tamponade can result in cardiogenic shock. […] Many cases of cardiogenic shock occurring after acute coronary syndromes may be due to medication administration. The use of beta blockers and angiotensin-converting enzyme (ACE) inhibitors in acute coronary syndromes must be carefully timed and monitored.

• #14 Cardiogenic shock

  https://www.openaccessjournals.com/articles/cardiogenic-shock-13122.html

  The cardiogenic shock is a state of endorgan dysfunction, secondary to insufficient cardiac output despite adequate preload, as a result of left ventricular, right ventricular or biventricular dysfunction. […] Cardiogenic shock occurs in up to 10% of patients presenting with acute myocardial infarction and is the leading cause of death. […] The most common cause of cardiogenic shock is acute coronary syndrome, accounting for about 70% to 80% of cardiogenic shock cases. Other causes of cardiogenic shock predominantly include the decompensation of chronic heart failure and right ventricular failure in about 5% of cases. […] Cardiogenic shock can be caused by an acute cardiac condition or a systemic illness that triggers a chronic cardiac condition associated with minimal cardiac reserve. Unstable angina, postcardiotomy syndrome, valvular heart disease, myocardial disease (such as myo-carditis), LV outflow obstruction in hypertrophic cardiomyopathy, stress-induced cardiomyopathy, pericardial tamponade, congenital lesions, and mechanical injury to the heart have all been implicated in the pathogenesis of cardiogenic shock. […] The most common cause of cardiogenic shock during acute myocardial infarction is left ventricle failure (78.5%), followed by severe mitral regurgitation (6.9%), ventricular septal rupture (3.9%), right ventricle failure (2.8%), and cardiac tamponade (1.4%).

• #15 Cardiogenic shock

  https://www.openaccessjournals.com/articles/cardiogenic-shock-13122.html

  The cardiogenic shock is a state of endorgan dysfunction, secondary to insufficient cardiac output despite adequate preload, as a result of left ventricular, right ventricular or biventricular dysfunction. […] Cardiogenic shock occurs in up to 10% of patients presenting with acute myocardial infarction and is the leading cause of death. […] The most common cause of cardiogenic shock is acute coronary syndrome, accounting for about 70% to 80% of cardiogenic shock cases. Other causes of cardiogenic shock predominantly include the decompensation of chronic heart failure and right ventricular failure in about 5% of cases. […] Cardiogenic shock can be caused by an acute cardiac condition or a systemic illness that triggers a chronic cardiac condition associated with minimal cardiac reserve. Unstable angina, postcardiotomy syndrome, valvular heart disease, myocardial disease (such as myo-carditis), LV outflow obstruction in hypertrophic cardiomyopathy, stress-induced cardiomyopathy, pericardial tamponade, congenital lesions, and mechanical injury to the heart have all been implicated in the pathogenesis of cardiogenic shock. […] The most common cause of cardiogenic shock during acute myocardial infarction is left ventricle failure (78.5%), followed by severe mitral regurgitation (6.9%), ventricular septal rupture (3.9%), right ventricle failure (2.8%), and cardiac tamponade (1.4%).

• #16

  https://journals.lww.com/co-criticalcare/fulltext/2021/08000/epidemiology_and_causes_of_cardiogenic_shock.12.aspx

  Cardiogenic shock is a complex clinical syndrome of end-organ hypoperfusion due to impaired cardiac performance. Although cardiogenic shock has traditionally been viewed as a monolithic disorder predominantly caused by severe left ventricular dysfunction complicating acute myocardial infarction (AMI), there is increasing recognition of the diverse causes of cardiogenic shock and wide spectrum of clinical severity. […] The proportion of cardiogenic shock cases related to AMI has decreased over time to 30%, while the proportion of cardiogenic shock cases due to acute decompensated heart failure has steadily increased.

• #17 Cardiogenic shock as a health issue. Physiology, classification, and detection | Medicina Intensiva

  https://www.medintensiva.org/en-cardiogenic-shock-as-health-issue–articulo-S2173572724000225

  Cardiogenic shock (CS) is a heterogeneous syndrome with high mortality and a growing incidence. It is characterized by an imbalance between the tissue oxygen demands and the capacity of the cardiovascular system to meet these demands, due to acute cardiac dysfunction. Historically, acute coronary syndromes have been the primary cause of CS. However, non-ischemic cases have seen a rise in incidence. The pathophysiology involves ischemic damage of the myocardium and a sympathetic, renin-angiotensin-aldosterone system and inflammatory response, perpetuating the situation of tissue hypoperfusion and ultimately leading to multiorgan dysfunction. […] Overall, the contribution of CS-ACS has decreased in the last two decades in parallel to an increase in CS of other etiologies. The main causes of non-ischemic CS (CS-NoACS) include non-ischemic cardiomyopathy, arrhythmias and severe valve disease. Patients with CS-NoACS have a greater burden of pre-existing heart failure, as well as atrial and ventricular arrhythmias, pulmonary hypertension and chronic kidney disease.

• #18 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 arises from an imbalance between input and demand, causing systemic hypoperfusion and organ dysfunction. […] Distinguishing between acute CS and acute-on-chronic CS is essential because mortality is higher in acute CS. […] In acute CS, there is a sudden reduction in ventricular contractility, leading to decreases in stroke volume, CO and blood pressure and increases in pulmonary capillary wedge pressure and central venous pressure. […] Chronic heart failure progresses to CS when impaired ventricular contractility is severe enough to cause a critical reduction in cardiac output (CO). […] Most epidemiological data on shock in critically ill patients focus on severe sepsis and septic shock, which are thought to be the leading causes of mortality in these patients. […] Although less frequent, cardiogenic shock (CS) remains a genuine clinical challenge with similar or even higher mortality rates.

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

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

  Data regarding CS epidemiology are predominantly derived from large registries of patients with CS secondary to AMI (AMI-CS). […] However, the prevalence of CS is variable according to the type ICU in which patients are being treated and is higher in cardiac ICUS compared to general ICUs. […] There are limited datasets that have incorporated CS across all its etiologies; therefore, comparison of outcomes between AMI and non-AMI-CS is still challenging. […] Patients with acute cardiac failure tend to have more severe shock presentations, higher lactate levels, and higher Sequential Organ Failure Assessment (SOFA) scores, even if they are less comorbid and have fewer cardio-vascular risk factors than those with CS due to acute-on-chronic heart failure. […] Consequently, in-hospital mortality appears to be higher in de novo cardiac dysfunction compared to acute-on-chronic heart failure-CS.

• #20 Cardiogenic shock – Wikipedia

  https://en.wikipedia.org/wiki/Cardiogenic_shock

  Causes of cardiogenic shock include cardiomyopathic, arrhythmic, and mechanical. Cardiogenic shock is most commonly precipitated by a heart attack. […] Cardiogenic shock is caused by the failure of the heart to pump effectively. It is due to damage to the heart muscle, most often from a heart attack or myocardial contusion. Other causes include abnormal heart rhythms, cardiomyopathy, heart valve problems, ventricular outflow obstruction (i.e. systolic anterior motion in hypertrophic cardiomyopathy), or ventriculoseptal defects. It can also be caused by a sudden decompressurization (e.g. in an aircraft), where air bubbles are released into the bloodstream (Henry’s law), causing heart failure.

• #21 Cardiogenic Shock: Practice Essentials, Background, Pathophysiology

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

  A systemic inflammatory response syndrometype mechanism has also been implicated in the etiology of cardiogenic shock. Elevated levels of white blood cells, body temperature, complement, interleukins, and C-reactive protein are often seen in large myocardial infarctions. […] The primary abnormality in systolic dysfunction is abated myocardial contractility. Acute MI or ischemia is the most common cause; cardiogenic shock is more likely to be associated with anterior MI. […] The causes of systolic dysfunction leading to cardiogenic shock can be summarized as follows: Ischemia/MI, Global hypoxemia, Valvular disease, Myocardial depressant drugs (eg, beta blockers, calcium-channel blockers, and antiarrhythmics), Myocardial contusion, Respiratory acidosis, Metabolic derangements (eg, acidosis, hypophosphatemia, and hypocalcemia), Severe myocarditis, End-stage cardiomyopathy (including valvular causes), Prolonged cardiopulmonary bypass, Cardiotoxic drugs (eg, doxorubicin [Adriamycin]). […] Increased LV diastolic chamber stiffness contributes to cardiogenic shock during cardiac ischemia, as well as in the late stages of hypovolemic shock and septic shock. […] Valvular dysfunction may immediately lead to cardiogenic shock, or it may aggravate other etiologies of shock.

• #22 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. […] CS is associated with high short-term mortality, and its management remains challenging despite recent advances in therapeutic options. […] It has several underlying aetiologies, the most common being acute myocardial infarction (AMI). Other less common causes include de novo subtypes of CS (fulminant myocarditis, right ventricular [RV] failure, Takotsubo syndrome, post-partum cardiomyopathy, end-stage valvular heart disease) and acute decompensation of other cardiomyopathies. […] De novo CS are mainly due to acute MI (AMI), unstable angina, postcardiotomy syndrome, valvular heart disease, myocardial disease (such as myocarditis), stress-induced cardiomyopathy, sepsis-induced cardiomyopathy, pericardial tamponade, congenital lesions, or/and mechanical injury to the heart.

• #23

  https://link.springer.com/article/10.1007/s12928-024-01031-3

  Takotsubo syndrome (TTS) can mimic acute coronary syndrome despite being a distinct disease. While typically benign, TTS can lead to serious complications like cardiogenic shock. Cardiogenic shock occurs in 120% of TTS cases. Various mechanisms can cause shock, including pump failure, right ventricular involvement, left ventricular outflow tract obstruction, and acute mitral regurgitation. […] Given the typical spontaneous recovery of ventricular systolic dysfunction, in-hospital management for TTS is primarily supportive. Because different mechanisms can be related to cardiogenic shock in patients with TTS, early identification of patients at high risk of cardiogenic shock and careful assessment for the etiology of cardiogenic shock are crucial. […] In the acute phase of TTS, various mechanisms can contribute to cardiogenic shock, including pump failure (e.g., extensive left ventricular wall motion abnormality), right ventricular (RV) involvement, left ventricular outflow tract obstruction (LVOTO), and acute mitral regurgitation (MR), often occurring in combination. Identifying the predominant mechanism underlying cardiogenic shock is crucial for selecting the most effective treatment strategy.

• #24

  https://link.springer.com/article/10.1007/s12928-024-01031-3

  Takotsubo syndrome (TTS) can mimic acute coronary syndrome despite being a distinct disease. While typically benign, TTS can lead to serious complications like cardiogenic shock. Cardiogenic shock occurs in 120% of TTS cases. Various mechanisms can cause shock, including pump failure, right ventricular involvement, left ventricular outflow tract obstruction, and acute mitral regurgitation. […] Given the typical spontaneous recovery of ventricular systolic dysfunction, in-hospital management for TTS is primarily supportive. Because different mechanisms can be related to cardiogenic shock in patients with TTS, early identification of patients at high risk of cardiogenic shock and careful assessment for the etiology of cardiogenic shock are crucial. […] In the acute phase of TTS, various mechanisms can contribute to cardiogenic shock, including pump failure (e.g., extensive left ventricular wall motion abnormality), right ventricular (RV) involvement, left ventricular outflow tract obstruction (LVOTO), and acute mitral regurgitation (MR), often occurring in combination. Identifying the predominant mechanism underlying cardiogenic shock is crucial for selecting the most effective treatment strategy.

• #25

  https://link.springer.com/article/10.1007/s12928-024-01031-3

  Cardiogenic shock is a major contributor to acute mortality in TTS, with reported incidence ranging from 1% to 20%. […] Cardiogenic shock is a serious complication of TTS arising from various mechanisms, including pump failure, RV involvement, LVOTO, and acute MR. Early and accurate identification of the underlying mechanism using echocardiography is crucial for selecting the most appropriate treatment approach.

• #26 Cardiogenic Shock – StatPearls – NCBI Bookshelf

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

  Cardiogenic shock is a primary cardiac disorder characterized by a low cardiac output state of circulatory failure that results in end-organ hypoperfusion and tissue hypoxia. […] The most common cause of cardiogenic shock is acute myocardial infarction, though other disorders leading to impairment of the myocardium, valves, conduction system, or pericardium also can result in cardiogenic shock. […] Various forms of cardiac dysfunction can cause cardiogenic shock. […] The most common causes of cardiogenic shock include: Acute myocardial ischemia, Mechanical defect: acute mitral regurgitation (papillary muscle rupture), ventricular wall rupture (septal or free wall), cardiac tamponade, left ventricular outflow obstruction (hypertrophic obstructive cardiomyopathy [HOCM], aortic stenosis [AS]), Left ventricular inflow obstruction (MS, atrial myxoma), Contractility defect: ischemic and non-ischemic cardiomyopathy, arrhythmias, septic shock with myocardial depression, myocarditis, Pulmonary embolus (right ventricular with or without left ventricular failure), Right ventricular failure, Aortic dissection, Other causes include cardiotoxic drugs (doxorubicin), medication overdose (beta/calcium channel blockers), metabolic derangements (acidosis), electrolyte abnormalities (calcium or phosphate).

• #27 Cardiogenic Shock: Causes, Symptoms, Treatment | Doctor

  https://patient.info/doctor/cardiogenic-shock

  Cardiogenic shock most commonly occurs as a complication of acute myocardial infarction (MI). It occurs in 7% of patients with ST-segment elevation MI and 3% with non ST-segment elevation MI. […] Cardiogenic shock is most often caused by acute MI, particularly affecting the anterior wall of the heart. […] Due to an intrinsic heart problem: MI. Myocardial contusion (often from steering wheel impact). Acute dysrhythmia compromising cardiac output. Acute mitral regurgitation (usually as a complication of MI due to ruptured chordae tendinae). Ventricular septal rupture (usually occurring as post-MI complication). Cardiac rupture (rupture of the wall of the left ventricle can occur post-MI or due to cardiac trauma). Hypertrophic obstructive cardiomyopathy or end-stage cardiomyopathy of other cause. Myocarditis. Post-cardiac surgery requiring prolonged cardioplegia and cardiopulmonary bypass. Severe valvular heart disease, particularly aortic stenosis.

• #28 Causes | SCAI – Seconds Count

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

  While the most common cause of cardiogenic shock (CS) is damage to the heart muscle resulting from a heart attack, other serious heart conditions may lead to CS, including some of the following: […] An abnormal heart rhythm (arrhythmia) […] Inflammation of your heart muscle (myocarditis) […] An infection of the valves of your heart (endocarditis) […] A blood clot that forms in one or more arteries in your lungs (pulmonary embolism) […] Heart failure (new or progressive worsening of heart pumping function) […] A major traumatic injury to your chest […] A heart valve problem such as severe leaking or tightness of the valve […] A tear in the inner layer of your aorta, the main artery of your heart (aortic dissection) […] Fluid or blood accumulation around your heart (cardiac tamponade) […] Overdose of certain heart medications like beta blockers or calcium channel blockers (rare)

• #29 Cardiogenic Shock: Causes, Symptoms, Treatment | Doctor

  https://patient.info/doctor/cardiogenic-shock

  Due to other causes: Acute, severe pulmonary embolism (PE). Pericardial tamponade or severe constrictive pericarditis. Tension pneumothorax. Myocardial suppression due to bacteraemia or sepsis (although, strictly speaking, this may be defined as septic shock). Suppression of myocardial contractility by drugs (eg, beta-blockers) or due to metabolic disturbance (eg, acidosis, hypokalaemia or hyperkalaemia, hypocalcaemia). Thyrotoxic crisis.

• #30 Cardiogenic Shock: Signs, Causes, and Treatments

  https://www.healthline.com/health/cardiogenic-shock

  Cardiogenic shock is most commonly the result of a heart attack. […] During a heart attack, the flow of blood through the arteries is restricted or blocked completely. This restriction can lead to cardiogenic shock. […] Other conditions that may cause cardiogenic shock include: sudden blockage of a blood vessel in the lung (pulmonary embolism), fluid buildup around the heart, reducing its filling capacity (pericardial tamponade), damage to the valves, allowing the backflow of blood (sudden valvular regurgitation), rupture of the wall of the heart due to increased pressure, inability of heart muscle to work properly, or at all in some cases, an arrhythmia in which the lower chambers fibrillate or quiver (ventricular fibrillation), an arrhythmia where the ventricles beat too fast (ventricular tachycardia). […] Drug overdoses can also affect the heart’s ability to pump blood and may lead to cardiogenic shock.

• #31 Air Care Series: Cardiogenic Shock — Taming the SRU

  https://www.tamingthesru.com/blog/air-care/cardiogenic-shock-in-hems

  Cardiogenic shock (CS), a state of tissue hypoperfusion secondary to inadequate cardiac output (CO), presents many challenges in both the pre-hospital and hospital setting. […] Despite many advances in both the medical and mechanical management of CS, the mortality remains relatively high at approximately 50%. […] The CS continuum begins with decreased stroke volume, which can be due to a myriad of etiologies though most typically is caused by ischemia. […] While there are many recognized causes of cardiogenic shock, both ischemic and non-ischemic, we will discuss the common causes which may alter the destination or medical management. Acute coronary syndrome is the most common cause of CS. […] In the CardShock study ST-segment myocardial infarction (STEMI) was the identified cause in 68% of the patients, while the SHOCK trial registry found myocardial ischemia to account for almost 78% of patients in acute CS. […] Cardiac arrhythmias can also be a significant contributing cause of CS.

• #32 Cardiogenic shock Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/cardiogenic-shock

  Cardiogenic shock takes place when the heart is unable to supply enough blood and oxygen to the organs of the body. […] The most common causes of cardiogenic shock are serious heart conditions. Many of these occur during or after a heart attack (myocardial infarction). These complications include: A large section of heart muscle that no longer moves well or does not move at all, Breaking open (rupture) of the heart muscle due to damage from the heart attack, Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia, Pressure on the heart due to a buildup of fluid around it (pericardial tamponade), Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve, Tear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers), Very slow heart rhythm (bradycardia) or problem with the electrical system of the heart (heart block).

• #33 Cardiogenic Shock Signs And Treatment | CPR First Aid

  https://cprfirstaid.com.au/cardiogenic-shock-causes-signs-and-treatment/

  Cardiogenic shock is a severe hemodynamic condition that occurs when the heart’s pumping ability is compromised, leading to inadequate blood flow and perfusion to vital organs. It often stems from heart diseases like: heart attack, heart failure, valvular problems, myocarditis, cardiomyopathy. […] Although heart problems and coronary artery disease are the most common causes, listed below are other etiologies: […] In many cases, cardiogenic shock is the result of acute coronary syndromes such as heart attack or an acute myocardial infarction. When the blood supply to the heart muscle is blocked, the heart can’t pump enough blood to meet the body’s needs. This can lead to organ damage and eventually, death. […] Arrhythmias can lead to cardiogenic shock in a number of ways. First, arrhythmias can cause the heart to beat too fast or too slow, which can reduce the amount of blood that is pumped through the body. This can lead to a decrease in blood pressure, which can cause shock.

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

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

  Cardiogenic shock is a life-limiting condition that happens suddenly when your heart cant pump enough blood to keep up with your bodys demand for it. A heart attack is the most common cause of cardiogenic shock. […] Cardiogenic shock is most often caused by a heart attack or heart failure. […] A heart attack is the most common cause of cardiogenic shock. A severe heart attack can damage your hearts main pumping chamber (left ventricle). When this happens, your body cant get enough oxygen-rich blood. […] Other conditions that make your heart weak and can lead to cardiogenic shock include: Damaged heart muscle from having a heart attack. Inflammation of your heart muscle (myocarditis). An infection of your hearts inner lining and valves (endocarditis). An abnormal heart rhythm (arrhythmia). Too much fluid or blood around your heart (cardiac tamponade). A blood clot that suddenly blocks a blood vessel in your lung (pulmonary embolism). A heart valve problem, such as torn muscles supporting your valve or an artificial valve not working right. Damage to the septum that divides the left and right ventricles of your heart. Heart failure. Injury to your chest.

• #35 Cardiogenic Shock: Signs, Causes, and Treatments

  https://www.healthline.com/health/cardiogenic-shock

  Cardiogenic shock is most commonly the result of a heart attack. […] During a heart attack, the flow of blood through the arteries is restricted or blocked completely. This restriction can lead to cardiogenic shock. […] Other conditions that may cause cardiogenic shock include: sudden blockage of a blood vessel in the lung (pulmonary embolism), fluid buildup around the heart, reducing its filling capacity (pericardial tamponade), damage to the valves, allowing the backflow of blood (sudden valvular regurgitation), rupture of the wall of the heart due to increased pressure, inability of heart muscle to work properly, or at all in some cases, an arrhythmia in which the lower chambers fibrillate or quiver (ventricular fibrillation), an arrhythmia where the ventricles beat too fast (ventricular tachycardia). […] Drug overdoses can also affect the heart’s ability to pump blood and may lead to cardiogenic shock.

• #36 Cardiogenic Shock: Causes, Symptoms, Treatment | Doctor

  https://patient.info/doctor/cardiogenic-shock

  Due to other causes: Acute, severe pulmonary embolism (PE). Pericardial tamponade or severe constrictive pericarditis. Tension pneumothorax. Myocardial suppression due to bacteraemia or sepsis (although, strictly speaking, this may be defined as septic shock). Suppression of myocardial contractility by drugs (eg, beta-blockers) or due to metabolic disturbance (eg, acidosis, hypokalaemia or hyperkalaemia, hypocalcaemia). Thyrotoxic crisis.

• #37 Cardiogenic Shock – Causes and Risk Factors | NHLBI, NIH

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

  A heart attack is the most common cause of cardiogenic shock. Less often, another heart problem or a problem somewhere else in the body blocks blood flow coming into or out of the heart and leads to cardiogenic shock. […] Cardiogenic shock usually develops very quickly when it follows a heart attack. Other heart conditions, such as heart failure or arrhythmia, can make it harder for the heart to deliver oxygen-rich blood to the organs, leading to cardiogenic shock. […] Cardiogenic shock can be caused by problems outside the heart, including fluid buildup in the chest, internal bleeding or blood loss, or pulmonary embolism, which occurs when a blood clot gets stuck in an artery of the lung. […] Rarely, some medicines can cause cardiogenic shock if you take a dose that is too high, or if your heart is not working well after a heart attack or other heart problem. […] The main cause of cardiogenic shock is a heart attack, which is a complication of coronary heart disease. […] Certain factors may increase your risk for cardiogenic shock. […] Cardiogenic shock may be more common in women than men.

• #38 Cardiogenic Shock: Signs, Causes, and Treatments

  https://www.healthline.com/health/cardiogenic-shock

  Cardiogenic shock is most commonly the result of a heart attack. […] During a heart attack, the flow of blood through the arteries is restricted or blocked completely. This restriction can lead to cardiogenic shock. […] Other conditions that may cause cardiogenic shock include: sudden blockage of a blood vessel in the lung (pulmonary embolism), fluid buildup around the heart, reducing its filling capacity (pericardial tamponade), damage to the valves, allowing the backflow of blood (sudden valvular regurgitation), rupture of the wall of the heart due to increased pressure, inability of heart muscle to work properly, or at all in some cases, an arrhythmia in which the lower chambers fibrillate or quiver (ventricular fibrillation), an arrhythmia where the ventricles beat too fast (ventricular tachycardia). […] Drug overdoses can also affect the heart’s ability to pump blood and may lead to cardiogenic shock.

• #39 Cardiogenic Shock

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

  Diastolic dysfunction: Increased left ventricular diastolic chamber stiffness contributes to cardiogenic shock commonly during myocardial ischemia, but also in the late stages of hypovolemic shock and septic shock. […] Valvular dysfunction: Valvular dysfunction may lead to cardiogenic shock acutely or may aggravate other etiologies of shock. […] Cardiac arrhythmia: Ventricular tachyarrhythmias often are associated with cardiogenic shock. […] Coronary artery disease: Cardiogenic shock generally is associated with the loss of more than 40% of the left ventricular myocardium, although predominantly RV infarction or the mechanical complications of MI (eg, acute mitral regurgitation, ventricular septal rupture, free wall rupture) also may lead to cardiogenic shock. […] Other causes: Mechanical complications such as acute mitral regurgitation, large RV infarction, and rupture of the interventricular septum or left ventricular free wall are other causes of cardiogenic shock.

• #40 Cardiogenic Shock: Causes, Symptoms, Diagnosis, and Treatment

  https://www.harleystreet.sg/kb/about-heart-disease/cardiogenic-shock/

  Viral or bacterial infections that cause heart muscle inflammation can lead to cardiogenic shock in severe cases. […] A buildup of fluid in the sac surrounding the heart (pericardium) can compress the heart, reducing its ability to pump blood. […] A large blood clot in the lungs can strain the heart, reducing blood circulation and potentially leading to cardiogenic shock.

• #41 Cardiogenic Shock

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

  Decreased contractility, RV infarction, Ischemia, Hypoxia, Acidosis. […] Right ventricular failure, Greatly increased afterload, Pulmonary embolism, Pulmonary vascular disease, Hypoxic pulmonary vasoconstriction, Peak end-expiratory pressure, High alveolar pressure, Acute respiratory distress syndrome, Pulmonary fibrosis, Sleep disordered breathing, Chronic obstructive pulmonary disease. […] Arrhythmias, Atrial and ventricular arrhythmias, Conduction abnormalities.

• #42 Cardiogenic Shock Causes, Stages, and Treatments – CVRTI

  https://cvrti.utah.edu/what-can-cause-cardiogenic-shock/

  Cardiogenic shock is a serious condition that can result in death if medical attention is not sought out quickly. This condition occurs when the heart is no longer able to pump enough blood to meet the needs of your body. […] This is the leading cause of death in people who have a heart attack. […] Even though its the top cause of death in people who have a heart attack, and it is the most common cause of cardiogenic shock, having a heart attack does not always lead to cardiogenic shock. […] The left ventricle is often the one that receives the most damage and causes cardiogenic shock. However, it could also happen to the right ventricle. […] In addition to heart attacks, you will find other potential causes of cardiogenic shock. There could be inflammation in the heart muscle or an infection in the heart. Those who suffer from an abnormal heart rhythm are at a higher risk of having cardiogenic shock, as well. […] Having too much blood around the heart, blood clots, or tears in the valves of the heart could lead to cardiogenic shock, too. […] Even if someone is considered healthy and has a good heart, an injury to the chest could damage the heart and lead to cardiogenic shock.

• #43 Cardiogenic Shock: Causes, Symptoms, Treatment | Doctor

  https://patient.info/doctor/cardiogenic-shock

  Cardiogenic shock most commonly occurs as a complication of acute myocardial infarction (MI). It occurs in 7% of patients with ST-segment elevation MI and 3% with non ST-segment elevation MI. […] Cardiogenic shock is most often caused by acute MI, particularly affecting the anterior wall of the heart. […] Due to an intrinsic heart problem: MI. Myocardial contusion (often from steering wheel impact). Acute dysrhythmia compromising cardiac output. Acute mitral regurgitation (usually as a complication of MI due to ruptured chordae tendinae). Ventricular septal rupture (usually occurring as post-MI complication). Cardiac rupture (rupture of the wall of the left ventricle can occur post-MI or due to cardiac trauma). Hypertrophic obstructive cardiomyopathy or end-stage cardiomyopathy of other cause. Myocarditis. Post-cardiac surgery requiring prolonged cardioplegia and cardiopulmonary bypass. Severe valvular heart disease, particularly aortic stenosis.

• #44 Cardiogenic Shock: Practice Essentials, Background, Pathophysiology

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

  A systemic inflammatory response syndrometype mechanism has also been implicated in the etiology of cardiogenic shock. Elevated levels of white blood cells, body temperature, complement, interleukins, and C-reactive protein are often seen in large myocardial infarctions. […] The primary abnormality in systolic dysfunction is abated myocardial contractility. Acute MI or ischemia is the most common cause; cardiogenic shock is more likely to be associated with anterior MI. […] The causes of systolic dysfunction leading to cardiogenic shock can be summarized as follows: Ischemia/MI, Global hypoxemia, Valvular disease, Myocardial depressant drugs (eg, beta blockers, calcium-channel blockers, and antiarrhythmics), Myocardial contusion, Respiratory acidosis, Metabolic derangements (eg, acidosis, hypophosphatemia, and hypocalcemia), Severe myocarditis, End-stage cardiomyopathy (including valvular causes), Prolonged cardiopulmonary bypass, Cardiotoxic drugs (eg, doxorubicin [Adriamycin]). […] Increased LV diastolic chamber stiffness contributes to cardiogenic shock during cardiac ischemia, as well as in the late stages of hypovolemic shock and septic shock. […] Valvular dysfunction may immediately lead to cardiogenic shock, or it may aggravate other etiologies of shock.

• #45 Cardiogenic Shock – StatPearls – NCBI Bookshelf

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

  Cardiogenic shock is a primary cardiac disorder characterized by a low cardiac output state of circulatory failure that results in end-organ hypoperfusion and tissue hypoxia. […] The most common cause of cardiogenic shock is acute myocardial infarction, though other disorders leading to impairment of the myocardium, valves, conduction system, or pericardium also can result in cardiogenic shock. […] Various forms of cardiac dysfunction can cause cardiogenic shock. […] The most common causes of cardiogenic shock include: Acute myocardial ischemia, Mechanical defect: acute mitral regurgitation (papillary muscle rupture), ventricular wall rupture (septal or free wall), cardiac tamponade, left ventricular outflow obstruction (hypertrophic obstructive cardiomyopathy [HOCM], aortic stenosis [AS]), Left ventricular inflow obstruction (MS, atrial myxoma), Contractility defect: ischemic and non-ischemic cardiomyopathy, arrhythmias, septic shock with myocardial depression, myocarditis, Pulmonary embolus (right ventricular with or without left ventricular failure), Right ventricular failure, Aortic dissection, Other causes include cardiotoxic drugs (doxorubicin), medication overdose (beta/calcium channel blockers), metabolic derangements (acidosis), electrolyte abnormalities (calcium or phosphate).

• #46 Causes | SCAI – Seconds Count

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

  While the most common cause of cardiogenic shock (CS) is damage to the heart muscle resulting from a heart attack, other serious heart conditions may lead to CS, including some of the following: […] An abnormal heart rhythm (arrhythmia) […] Inflammation of your heart muscle (myocarditis) […] An infection of the valves of your heart (endocarditis) […] A blood clot that forms in one or more arteries in your lungs (pulmonary embolism) […] Heart failure (new or progressive worsening of heart pumping function) […] A major traumatic injury to your chest […] A heart valve problem such as severe leaking or tightness of the valve […] A tear in the inner layer of your aorta, the main artery of your heart (aortic dissection) […] Fluid or blood accumulation around your heart (cardiac tamponade) […] Overdose of certain heart medications like beta blockers or calcium channel blockers (rare)

• #47 Cardiogenic shock: evolving definitions and future directions in management | Open Heart

  https://openheart.bmj.com/content/6/1/e000960

  Cardiogenic shock (CS) is a complex and highly morbid entity conceptualised as a vicious cycle of injury, cardiac and systemic decompensation, and further injury and decompensation. […] The generally accepted definition of CS is a state in which ineffective cardiac output (CO) due to a primary cardiac dysfunction results in inadequate end-organ perfusion. […] Although AMI is the most common aetiology, consideration of other cardiac (eg, right heart failure, myopericarditis, arrhythmia, takotsubo cardiomyopathy, hyperthrophic cardiomyopathy, valvular heart disease, postpartum cardiomyopathy) and extracardiac (eg, aortic dissection with acute aortic stenosis or myocardial infarction, traumatic chordal rupture, massive pulmonary embolism) causes must also be rapidly diagnosed in parallel and if present, managed uniquely. […] Maladaptive compensatory mechanisms accelerate the self-perpetuation of injury. […] Any cause of acute, severe impairment of CO can trigger this cascade and precipitate CS.

• #48 Cardiogenic shock – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cardiogenic-shock/symptoms-causes/syc-20366739

  Cardiogenic shock is a life-threatening condition in which your heart suddenly can’t pump enough blood to meet your body’s needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock. […] In most cases, a lack of oxygen to your heart, usually from a heart attack, damages its main pumping chamber (left ventricle). Without oxygen-rich blood flowing to that area of your heart, the heart muscle can weaken and go into cardiogenic shock. […] Rarely, damage to your heart’s right ventricle, which sends blood to your lungs to get oxygen, leads to cardiogenic shock. […] Other possible causes of cardiogenic shock include: Inflammation of the heart muscle (myocarditis), Infection of the heart valves (endocarditis), Weakened heart from any cause, Drug overdoses or poisoning with substances that can affect your heart’s pumping ability.

• #49 What Are Cardiogenic Shock Causes?

  https://www.webmd.com/heart-disease/what-are-cardiogenic-shock-causes

  Cardiogenic shock is caused by a failure in one of the two bottom chambers of your heart. It happens when your heart can’t pump oxygen-filled blood to the rest of your body. This will lead to organ failure and death. […] In 81% of cases, the underlying cause is a blockage of blood from the heart, which causes a heart attack. […] Other cardiogenic shock causes include: Conditions that impact the tissues of the heart. This includes myocarditis, an inflammation of the muscle, and endocarditis, an inflammation or infection of the inner lining and valves. […] Drug side effects. This can include overdosing on some drugs, poisoning, and in rare cases as a side effect from a prescription beta-blocker or calcium channel blocker. […] Previous injury. Your ventricles may be weakened from a previous heart attack or a hard hit to your body a car crash, for example may damage the ventricles.

• #50 Cardiogenic Shock: Practice Essentials, Background, Pathophysiology

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

  A systemic inflammatory response syndrometype mechanism has also been implicated in the etiology of cardiogenic shock. Elevated levels of white blood cells, body temperature, complement, interleukins, and C-reactive protein are often seen in large myocardial infarctions. […] The primary abnormality in systolic dysfunction is abated myocardial contractility. Acute MI or ischemia is the most common cause; cardiogenic shock is more likely to be associated with anterior MI. […] The causes of systolic dysfunction leading to cardiogenic shock can be summarized as follows: Ischemia/MI, Global hypoxemia, Valvular disease, Myocardial depressant drugs (eg, beta blockers, calcium-channel blockers, and antiarrhythmics), Myocardial contusion, Respiratory acidosis, Metabolic derangements (eg, acidosis, hypophosphatemia, and hypocalcemia), Severe myocarditis, End-stage cardiomyopathy (including valvular causes), Prolonged cardiopulmonary bypass, Cardiotoxic drugs (eg, doxorubicin [Adriamycin]). […] Increased LV diastolic chamber stiffness contributes to cardiogenic shock during cardiac ischemia, as well as in the late stages of hypovolemic shock and septic shock. […] Valvular dysfunction may immediately lead to cardiogenic shock, or it may aggravate other etiologies of shock.

• #51 Causes | SCAI – Seconds Count

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

  While the most common cause of cardiogenic shock (CS) is damage to the heart muscle resulting from a heart attack, other serious heart conditions may lead to CS, including some of the following: […] An abnormal heart rhythm (arrhythmia) […] Inflammation of your heart muscle (myocarditis) […] An infection of the valves of your heart (endocarditis) […] A blood clot that forms in one or more arteries in your lungs (pulmonary embolism) […] Heart failure (new or progressive worsening of heart pumping function) […] A major traumatic injury to your chest […] A heart valve problem such as severe leaking or tightness of the valve […] A tear in the inner layer of your aorta, the main artery of your heart (aortic dissection) […] Fluid or blood accumulation around your heart (cardiac tamponade) […] Overdose of certain heart medications like beta blockers or calcium channel blockers (rare)

• #52 Cardiogenic Shock: Practice Essentials, Background, Pathophysiology

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

  A systemic inflammatory response syndrometype mechanism has also been implicated in the etiology of cardiogenic shock. Elevated levels of white blood cells, body temperature, complement, interleukins, and C-reactive protein are often seen in large myocardial infarctions. […] The primary abnormality in systolic dysfunction is abated myocardial contractility. Acute MI or ischemia is the most common cause; cardiogenic shock is more likely to be associated with anterior MI. […] The causes of systolic dysfunction leading to cardiogenic shock can be summarized as follows: Ischemia/MI, Global hypoxemia, Valvular disease, Myocardial depressant drugs (eg, beta blockers, calcium-channel blockers, and antiarrhythmics), Myocardial contusion, Respiratory acidosis, Metabolic derangements (eg, acidosis, hypophosphatemia, and hypocalcemia), Severe myocarditis, End-stage cardiomyopathy (including valvular causes), Prolonged cardiopulmonary bypass, Cardiotoxic drugs (eg, doxorubicin [Adriamycin]). […] Increased LV diastolic chamber stiffness contributes to cardiogenic shock during cardiac ischemia, as well as in the late stages of hypovolemic shock and septic shock. […] Valvular dysfunction may immediately lead to cardiogenic shock, or it may aggravate other etiologies of shock.

• #53 Cardiogenic Shock: Emergency Department-Focused Management – emDocs

  https://www.emdocs.net/cardiogenic-shock-emergency-department-focused-management/

  It may be helpful to categorize etiologies of CS by their underlying cause (e.g. Structure, Squeeze, and Stoppage). […] The first step in treating CS is recognizing it. A good first step in evaluating for undifferentiated shock in the emergency department is the Rapid Ultrasound for Shock and Hypotension (RUSH) exam. […] The goal of ED treatment in VSR is the reduction of afterload to decrease the left-to-right shunt. […] The pathophysiology of sepsis-induced CS is not completely understood, but it presents with some or (often) all of the following: LV dysfunction, RV dysfunction, and dilation of both ventricles. […] Sepsis-induced CS is often defined by its acute nature, absence of acute coronary syndrome (ACS), and reversibility after the primary insult is resolved. […] AMI is the primary cause for 70% of all cases of CS. CS is more likely to result from ST-elevation myocardial infarction (STEMI) than non-STEMI (NSTEMI). […] For patients with confirmed AMI causing CS, definitive care is reperfusion therapy.

• #54 Acute decompensated heart failure (including cardiogenic shock) – EMCrit Project

  https://emcrit.org/ibcc/chf/

  To make things confusing, cardiogenic shock may trigger a systemic inflammatory response with elevated cytokine levels and reduced systemic vascular resistance. This may occur later in the course of cardiogenic shock, possibly due to ischemic tissue damage. […] This condition will mimic septic shock. […] Advanced-stage septic shock and advanced-stage cardiogenic shock can look clinically quite similar (e.g., shock, vasodilation, reduced systolic heart failure, systemic inflammation).

• #55 Cardiogenic Shock Signs And Treatment | CPR First Aid

  https://cprfirstaid.com.au/cardiogenic-shock-causes-signs-and-treatment/

  A cardiac tamponade or fluid buildup around the heart can lead to cardiogenic shock when the pressure in the pericardial sac becomes so great that it interferes with the heart’s ability to pump blood. […] Severe heart valve problems can lead to cardiogenic shock by causing the heart to pump less efficiently and preventing enough blood from reaching the rest of the body. […] Severe lung disease can lead to cardiogenic shock by impairing the heart’s ability to pump blood effectively. This can result in a drop in blood pressure and decreased blood flow to the organs. […] Sepsis can lead to cardiogenic shock in several ways. First, sepsis can cause low blood pressure (hypotension), which reduces the amount of blood that reaches the heart. Second, sepsis can cause the heart to become less efficient in pumping blood (myocardial dysfunction). […] Chronic heart failure is one of the leading risk factors for cardiogenic shock in the country. When it is not effectively managed, it can progress to a severe state where the heart’s pumping capacity is compromised, increasing the risk of cardiogenic shock.

• #56 Cardiogenic Shock: Emergency Department-Focused Management – emDocs

  https://www.emdocs.net/cardiogenic-shock-emergency-department-focused-management/

  It may be helpful to categorize etiologies of CS by their underlying cause (e.g. Structure, Squeeze, and Stoppage). […] The first step in treating CS is recognizing it. A good first step in evaluating for undifferentiated shock in the emergency department is the Rapid Ultrasound for Shock and Hypotension (RUSH) exam. […] The goal of ED treatment in VSR is the reduction of afterload to decrease the left-to-right shunt. […] The pathophysiology of sepsis-induced CS is not completely understood, but it presents with some or (often) all of the following: LV dysfunction, RV dysfunction, and dilation of both ventricles. […] Sepsis-induced CS is often defined by its acute nature, absence of acute coronary syndrome (ACS), and reversibility after the primary insult is resolved. […] AMI is the primary cause for 70% of all cases of CS. CS is more likely to result from ST-elevation myocardial infarction (STEMI) than non-STEMI (NSTEMI). […] For patients with confirmed AMI causing CS, definitive care is reperfusion therapy.

• #57 Cardiogenic Shock: Practice Essentials, Background, Pathophysiology

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

  A systemic inflammatory response syndrometype mechanism has also been implicated in the etiology of cardiogenic shock. Elevated levels of white blood cells, body temperature, complement, interleukins, and C-reactive protein are often seen in large myocardial infarctions. […] The primary abnormality in systolic dysfunction is abated myocardial contractility. Acute MI or ischemia is the most common cause; cardiogenic shock is more likely to be associated with anterior MI. […] The causes of systolic dysfunction leading to cardiogenic shock can be summarized as follows: Ischemia/MI, Global hypoxemia, Valvular disease, Myocardial depressant drugs (eg, beta blockers, calcium-channel blockers, and antiarrhythmics), Myocardial contusion, Respiratory acidosis, Metabolic derangements (eg, acidosis, hypophosphatemia, and hypocalcemia), Severe myocarditis, End-stage cardiomyopathy (including valvular causes), Prolonged cardiopulmonary bypass, Cardiotoxic drugs (eg, doxorubicin [Adriamycin]). […] Increased LV diastolic chamber stiffness contributes to cardiogenic shock during cardiac ischemia, as well as in the late stages of hypovolemic shock and septic shock. […] Valvular dysfunction may immediately lead to cardiogenic shock, or it may aggravate other etiologies of shock.

• #58 Cardiogenic Shock: Causes, Symptoms, Treatment | Doctor

  https://patient.info/doctor/cardiogenic-shock

  Due to other causes: Acute, severe pulmonary embolism (PE). Pericardial tamponade or severe constrictive pericarditis. Tension pneumothorax. Myocardial suppression due to bacteraemia or sepsis (although, strictly speaking, this may be defined as septic shock). Suppression of myocardial contractility by drugs (eg, beta-blockers) or due to metabolic disturbance (eg, acidosis, hypokalaemia or hyperkalaemia, hypocalcaemia). Thyrotoxic crisis.

• #59 Cardiogenic Shock (CS): Causes, Symptoms, Management – We Care

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

  Cardiogenic shock occurs when more than 40% of the left ventricle dies, usually because of the obstruction of major coronary veins. […] Several heart diseases are the reason for a severe reduction in the pumping capacity of the heart. […] The common cause of cardiogenic shock is acute MI (heart attack). However, other heart diseases like cardiomyopathies, severe arrhythmias, or valvular heart disease may also be responsible for cardiogenic shock. […] Coronary causes (most common) include acute MI. […] Non-coronary causes include severe hypoxemia, acidosis, and hypoglycemia. […] Other causes include severe heart failure, cardiac arrhythmias, structural heart problems, endocarditis, myocarditis, drug overdose, cardiac tamponade, tension pneumothorax, massive pulmonary embolism, severe hypertension, and poisoning with substances that can affect heart-pumping ability.

• #60 Cardiogenic Shock – StatPearls – NCBI Bookshelf

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

  Cardiogenic shock is a primary cardiac disorder characterized by a low cardiac output state of circulatory failure that results in end-organ hypoperfusion and tissue hypoxia. […] The most common cause of cardiogenic shock is acute myocardial infarction, though other disorders leading to impairment of the myocardium, valves, conduction system, or pericardium also can result in cardiogenic shock. […] Various forms of cardiac dysfunction can cause cardiogenic shock. […] The most common causes of cardiogenic shock include: Acute myocardial ischemia, Mechanical defect: acute mitral regurgitation (papillary muscle rupture), ventricular wall rupture (septal or free wall), cardiac tamponade, left ventricular outflow obstruction (hypertrophic obstructive cardiomyopathy [HOCM], aortic stenosis [AS]), Left ventricular inflow obstruction (MS, atrial myxoma), Contractility defect: ischemic and non-ischemic cardiomyopathy, arrhythmias, septic shock with myocardial depression, myocarditis, Pulmonary embolus (right ventricular with or without left ventricular failure), Right ventricular failure, Aortic dissection, Other causes include cardiotoxic drugs (doxorubicin), medication overdose (beta/calcium channel blockers), metabolic derangements (acidosis), electrolyte abnormalities (calcium or phosphate).

• #61 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

  In 1939, Harrison introduced cardiogenic shock (CS) as a specific entity and differentiated it from other forms of shock. Acute MI (AMI) is the most common cause of CS and has a mortality rate of up to 50%, which has changed little in the past two decades. […] Although AMI is the most common cause of CS, there are many more phenotypes of patients with acute heart failure, which adds complexity to screening and randomizing patients for a trial in time-pressured circumstances. […] The key question in management of CS is how to interrupt the vicious cycle of CS progression. With AMICS, revascularization is crucial; nonetheless, evolving CS has to be treated symptomatically. Inotropic and vasopressor support has shown to have limited benefit or even cause harm in CS.

• #62 Cardiogenic Shock | Thoracic Key

  https://thoracickey.com/cardiogenic-shock-7/

  The pathogenesis of CS is largely determined by 1. the initial substantial myocardial damage, generally of ischemic genesis with consecutively marked systolic and diastolic cardiac dysfunction, 2. the consecutively precipitated compensatory, mainly neuro-endocrine reply, and 3. the associated systemic inflammatory response, the latter with inherent vasodilatory properties, thereby altering macro- but also microcirculatory hemodynamics [52, 54, 55, 61, 65, 82, 86, 87, 108].

• #63 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

  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 reduction in tissue perfusion results in decreased oxygen and nutrient delivery to the tissues and, if prolonged, potentially end-organ damage and multi-system failure. […] 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.

• #64 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 arises from an imbalance between input and demand, causing systemic hypoperfusion and organ dysfunction. […] Distinguishing between acute CS and acute-on-chronic CS is essential because mortality is higher in acute CS. […] In acute CS, there is a sudden reduction in ventricular contractility, leading to decreases in stroke volume, CO and blood pressure and increases in pulmonary capillary wedge pressure and central venous pressure. […] Chronic heart failure progresses to CS when impaired ventricular contractility is severe enough to cause a critical reduction in cardiac output (CO). […] Most epidemiological data on shock in critically ill patients focus on severe sepsis and septic shock, which are thought to be the leading causes of mortality in these patients. […] Although less frequent, cardiogenic shock (CS) remains a genuine clinical challenge with similar or even higher mortality rates.

• #65

  https://step2.medbullets.com/cardiovascular/120760/cardiogenic-shock

  Clinical definition: shock secondary to dysfunction of the heart and pump failure […] the heart is unable to generate sufficient cardiac output to maintain tissue perfusion. […] Etiology: Cardiomyopic […] myocardial infarction (MI) (most common cause) […] cardiomyopathy […] myocarditis […] drug-induced. […] Pathogenesis: an underlying event (such as MI) results in cardiac output, which causes perfusion to tissue […] cardiac output and blood pressure causes […] catecholamines, which vasoconstriction and myocardial oxygen demand […] renin-angiotensin-aldosterone system, which vasoconstriction and retention of sodium and water. […] Symptoms: symptoms depend on etiology […] myocardial infarction […] chest pain […] dyspnea […] arrhythmias […] palpitations […] syncope.

• #66 Cardiogenic Shock | Thoracic Key

  https://thoracickey.com/cardiogenic-shock-7/

  The pathogenesis of CS is largely determined by 1. the initial substantial myocardial damage, generally of ischemic genesis with consecutively marked systolic and diastolic cardiac dysfunction, 2. the consecutively precipitated compensatory, mainly neuro-endocrine reply, and 3. the associated systemic inflammatory response, the latter with inherent vasodilatory properties, thereby altering macro- but also microcirculatory hemodynamics [52, 54, 55, 61, 65, 82, 86, 87, 108].

• #67

  https://step2.medbullets.com/cardiovascular/120760/cardiogenic-shock

  Clinical definition: shock secondary to dysfunction of the heart and pump failure […] the heart is unable to generate sufficient cardiac output to maintain tissue perfusion. […] Etiology: Cardiomyopic […] myocardial infarction (MI) (most common cause) […] cardiomyopathy […] myocarditis […] drug-induced. […] Pathogenesis: an underlying event (such as MI) results in cardiac output, which causes perfusion to tissue […] cardiac output and blood pressure causes […] catecholamines, which vasoconstriction and myocardial oxygen demand […] renin-angiotensin-aldosterone system, which vasoconstriction and retention of sodium and water. […] Symptoms: symptoms depend on etiology […] myocardial infarction […] chest pain […] dyspnea […] arrhythmias […] palpitations […] syncope.

• #68 Cardiogenic Shock: Practice Essentials, Background, Pathophysiology

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

  A systemic inflammatory response syndrometype mechanism has also been implicated in the etiology of cardiogenic shock. Elevated levels of white blood cells, body temperature, complement, interleukins, and C-reactive protein are often seen in large myocardial infarctions. […] The primary abnormality in systolic dysfunction is abated myocardial contractility. Acute MI or ischemia is the most common cause; cardiogenic shock is more likely to be associated with anterior MI. […] The causes of systolic dysfunction leading to cardiogenic shock can be summarized as follows: Ischemia/MI, Global hypoxemia, Valvular disease, Myocardial depressant drugs (eg, beta blockers, calcium-channel blockers, and antiarrhythmics), Myocardial contusion, Respiratory acidosis, Metabolic derangements (eg, acidosis, hypophosphatemia, and hypocalcemia), Severe myocarditis, End-stage cardiomyopathy (including valvular causes), Prolonged cardiopulmonary bypass, Cardiotoxic drugs (eg, doxorubicin [Adriamycin]). […] Increased LV diastolic chamber stiffness contributes to cardiogenic shock during cardiac ischemia, as well as in the late stages of hypovolemic shock and septic shock. […] Valvular dysfunction may immediately lead to cardiogenic shock, or it may aggravate other etiologies of shock.

• #69 Cardiogenic shock as a health issue. Physiology, classification, and detection | Medicina Intensiva

  https://www.medintensiva.org/en-cardiogenic-shock-as-health-issue–articulo-S2173572724000225

  Cardiogenic shock (CS) is a heterogeneous syndrome with high mortality and a growing incidence. It is characterized by an imbalance between the tissue oxygen demands and the capacity of the cardiovascular system to meet these demands, due to acute cardiac dysfunction. Historically, acute coronary syndromes have been the primary cause of CS. However, non-ischemic cases have seen a rise in incidence. The pathophysiology involves ischemic damage of the myocardium and a sympathetic, renin-angiotensin-aldosterone system and inflammatory response, perpetuating the situation of tissue hypoperfusion and ultimately leading to multiorgan dysfunction. […] Overall, the contribution of CS-ACS has decreased in the last two decades in parallel to an increase in CS of other etiologies. The main causes of non-ischemic CS (CS-NoACS) include non-ischemic cardiomyopathy, arrhythmias and severe valve disease. Patients with CS-NoACS have a greater burden of pre-existing heart failure, as well as atrial and ventricular arrhythmias, pulmonary hypertension and chronic kidney disease.

• #70 Cardiogenic shock in ACS. Part 1: prediction, presentation and medical therapy | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2011.194

  Ischemic cardiogenic shock is a complex, self-perpetuating pathological process that frequently causes death irrespective of medical therapy. […] Emergence of shock depends upon the volume of ischemic myocardium, stroke volume, and peripheral vascular resistance. […] Cytokine release can trigger the systemic inflammatory response, causing low peripheral vascular resistance and profound refractory shock in around one-third of cases. […] Management of primary left ventricular failure involves early reperfusion and administration of adrenergic inotropes and vasopressors; right ventricular failure is treated with volume loading, inotropes, and pulmonary vasodilators. […] When mean arterial pressure is 55 mmHg, serum lactate 11 mmol/l, base deficit 12 mmol/l, and SvO2 65% despite medical therapy, recovery is unlikely without mechanical circulatory support.

• #71 Cardiogenic Shock | Thoracic Key

  https://thoracickey.com/cardiogenic-shock-7/

  The most common causes of cardiogenic shock are [12, 3638]: acute impairment of myocardial pump function from: acute myocardial infarction and associated complications, including rupture of a papillary muscle or septum, severe MR and pericardial tamponade, acute myocarditis, intoxication with negatively inotropic drugs, myocardial contusion, sepsis and septic shock. […] LV-dysfunction is the main reason for the development of cardiogenic shock also in patients not suffering from CAD and thus not a result of ischaemia [25, 26]. […] The mismatch between marked myocardial depression caused by loss of contractile mass [24, 37, 40, 54], ischemia-reperfusion injury [42, 49, 65, 8285], cardiodepressent substances [82, 89, 90, 109], and the inappropriate vasodilation may result in CS [63, 64].

• #72 Cardiogenic shock in ACS. Part 1: prediction, presentation and medical therapy | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2011.194

  Ischemic cardiogenic shock is a complex, self-perpetuating pathological process that frequently causes death irrespective of medical therapy. […] Emergence of shock depends upon the volume of ischemic myocardium, stroke volume, and peripheral vascular resistance. […] Cytokine release can trigger the systemic inflammatory response, causing low peripheral vascular resistance and profound refractory shock in around one-third of cases. […] Management of primary left ventricular failure involves early reperfusion and administration of adrenergic inotropes and vasopressors; right ventricular failure is treated with volume loading, inotropes, and pulmonary vasodilators. […] When mean arterial pressure is 55 mmHg, serum lactate 11 mmol/l, base deficit 12 mmol/l, and SvO2 65% despite medical therapy, recovery is unlikely without mechanical circulatory support.

• #73 Cardiogenic Shock – REBEL EM – Emergency Medicine Blog

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

  Definition: Tissue hypoperfusion that is primarily attributable to damage to the heart. […] Causes: Acute myocardial infarction (AMI) is the most common cause of cardiogenic shock. Below is a list of other diagnostic considerations that should be entertained: […] AMI is the most common cause of cardiogenic shock and represents one of the fixable etiologies. […] The pathophysiology in AMI induced cardiogenic shock is the most clear: AMI leads to LV dysfunction + systemic hypoperfusion. […] This process spirals creating a vicious cycle:

• #74 Cardiogenic Shock: Emergency Department-Focused Management – emDocs

  https://www.emdocs.net/cardiogenic-shock-emergency-department-focused-management/

  Cardiogenic shock (CS) is the result of pump failure, and it is characterized by the inability of the cardiac output to adequately meet the oxygen needs of the peripheral tissues. The most common cause is MI, followed by dysrhythmias, heart failure, and valvular disease. The downstream cascade has a common pathway regardless of the inciting event: decreased cardiac output leads to myocardial ischemia, which triggers compensatory hormonal responses that paradoxically create a positive feedback loop, promoting further ischemia. Although there has yet to be universally accepted criteria to define CS, some of the landmark trials such as SHOCK and IABP-SHOCK propose a cluster of similar descriptors: hypotension, end-organ hypoperfusion, a cardiac index (CI) <2.2 L/min/m², and high pulmonary capillary wedge pressure (PCWP) ≥15 mmHg. Not all findings need to be present for the diagnosis of CS to be made.

• #75 Cardiogenic Shock: Emergency Department-Focused Management – emDocs

  https://www.emdocs.net/cardiogenic-shock-emergency-department-focused-management/

  Cardiogenic shock (CS) is the result of pump failure, and it is characterized by the inability of the cardiac output to adequately meet the oxygen needs of the peripheral tissues. The most common cause is MI, followed by dysrhythmias, heart failure, and valvular disease. The downstream cascade has a common pathway regardless of the inciting event: decreased cardiac output leads to myocardial ischemia, which triggers compensatory hormonal responses that paradoxically create a positive feedback loop, promoting further ischemia. Although there has yet to be universally accepted criteria to define CS, some of the landmark trials such as SHOCK and IABP-SHOCK propose a cluster of similar descriptors: hypotension, end-organ hypoperfusion, a cardiac index (CI) <2.2 L/min/m², and high pulmonary capillary wedge pressure (PCWP) ≥15 mmHg. Not all findings need to be present for the diagnosis of CS to be made.

• #76 Cardiogenic shock as a health issue. Physiology, classification, and detection | Medicina Intensiva

  https://www.medintensiva.org/en-cardiogenic-shock-as-health-issue–articulo-S2173572724000225

  In CS-NoACS, the index event is not so clearly identifiable. This is the case for example in cardiomyopathy with ventricular dysfunction, where a supraventricular arrhythmia, a subtle increase in congestion, or anemization can cause compensated chronic heart failure (HF) to evolve towards CS. […] In both cases (CS-ACS and CS-NoACS), the decrease in myocardial contraction capacity to below the threshold required to sustain cardiac output in accordance with the physiological demands results in changes at cardiac and systemic level that seek to maintain cardiac output. If these adjustments prove ineffective, a vicious circle is generated, leading to multiorgan failure and the death of the patient.

• #77 Cardiogenic shock: evolving definitions and future directions in management | Open Heart

  https://openheart.bmj.com/content/6/1/e000960

  Cardiogenic shock (CS) is a complex and highly morbid entity conceptualised as a vicious cycle of injury, cardiac and systemic decompensation, and further injury and decompensation. […] The generally accepted definition of CS is a state in which ineffective cardiac output (CO) due to a primary cardiac dysfunction results in inadequate end-organ perfusion. […] Although AMI is the most common aetiology, consideration of other cardiac (eg, right heart failure, myopericarditis, arrhythmia, takotsubo cardiomyopathy, hyperthrophic cardiomyopathy, valvular heart disease, postpartum cardiomyopathy) and extracardiac (eg, aortic dissection with acute aortic stenosis or myocardial infarction, traumatic chordal rupture, massive pulmonary embolism) causes must also be rapidly diagnosed in parallel and if present, managed uniquely. […] Maladaptive compensatory mechanisms accelerate the self-perpetuation of injury. […] Any cause of acute, severe impairment of CO can trigger this cascade and precipitate CS.

• #78 Organ dysfunction, injury, and failure in cardiogenic shock | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-023-00676-1

  Cardiogenic shock (CS) is caused by primary cardiac dysfunction and induced by various and heterogeneous diseases (e.g., acute impairment of cardiac performance, or acute or chronic impairment of cardiac performance). […] CS is mainly caused by ACS and HF etiologies. Its incidence is approximately 613% in ACS and 4% in acute HF. The etiological spectrum of CS is also broad and may include numerous other etiologies, such as ischemic cardiomyopathy without acute myocardial infarction (AMI), non-ischemic cardiomyopathy, incessant ventricular arrythmia, and severe valvular disease. […] Hypoperfusion by CS could lead to injury, impairment, and failure of affected organs (i.e., heart, lungs, kidney, liver, intestines, brain), which was so-called forward failure. Meanwhile, venous congestion due to elevation of the right atrial pressure and high venous pressure by CS could lead to congestive organ damages (kidney, liver and intestines), which was so-called backward failure.

• #79 Organ dysfunction, injury, and failure in cardiogenic shock | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-023-00676-1

  AKI has been traditionally attributed to the hypoperfusion of the kidneys through progressive impairment of the cardiac output or intravascular volume depletion secondary to CS. However, attention has shifted from cardiac output (forward failure) to venous congestion (backward failure) as the most important hemodynamic determinant. […] The development of congestive kidney failure induced by the increased renal venous pressure arising from venous congestion (increased renal after-load) and increased renal interstitial pressure (intrinsic renal compromise) might play an important role in the development of AKI in patients with CS.

• #80 Cardiogenic Shock

  https://med.uth.edu/heartandvascular/cardiogenic-shock/

  Cardiogenic shock can be broadly categorized into two types based on the underlying cause: […] Acute myocardial infarction (AMI) cardiogenic shock: This type occurs as a complication of a heart attack when a significant portion of the heart muscle is damaged, leading to impaired pumping function. […] Non-AMI cardiogenic shock: This type can be caused by various conditions other than a heart attack, such as severe heart failure, myocarditis (inflammation of the heart muscle), arrhythmias, or structural heart defects. […] The primary cause of cardiogenic shock is a significant decrease in the hearts pumping ability. This can be due to various factors, including: […] Myocardial infarction (heart attack): The most common cause of cardiogenic shock is a heart attack that damages a large area of the heart muscle.

• #81 Etiology-Specific Trends in Cardiogenic Shock From 2010 to 2020

  https://www.thecardiologyadvisor.com/news/etiology-specific-trends-in-cardiogenic-shock-from-2010-to-2020/

  Mortality related to cardiogenic shock has decreased during the past decade, but mortality related to HF-cardiogenic shock remains high. […] Cardiogenic shock can be caused by acute myocardial infarction (AMI) or heart failure (HF) and be related to ischemic cardiomyopathy (ICM) or not. […] HF-CS was associated with a higher mortality rate and greater necessity for cardiac replacement therapy compared to AMI-CS, a pattern that persisted even post-discharge and after successful recovery from CS. […] The study authors concluded, HF-CS was associated with a higher mortality rate and greater necessity for cardiac replacement therapy compared to AMI-CS, a pattern that persisted even post-discharge and after successful recovery from CS.

• #82 Mastering the myocardium: Cardiogenic Shock – EMOttawa Blog

  https://emottawablog.com/2021/09/mastering-the-myocardium-recognition-and-resuscitation-of-the-patient-in-cardiogenic-shock/

  Cardiogenic shock comprises approximately 15% of cases in patients presenting to the ED with shock. The majority of cardiogenic shock is due to underlying acute coronary syndrome (ACS). However, its contribution has declined over the past two decades with a parallel increase of other non-ACS etiologies. A large North American CCU dataset in 2019 showed that only 1/3 of CS was related to ACS, while the remainder included causes such as cardiomyopathies, valvular diseases, and arrhythmias. The main causes of cardiogenic shock can be broken down into ACS vs. non-ACS etiologies. […] Despite advancements in STEMI bypass systems, revascularization therapies, and mechanical circulatory support (MCS), the mortality rate for CS remains high.

• #83 Cardiogenic shock as a health issue. Physiology, classification, and detection | Medicina Intensiva

  https://www.medintensiva.org/en-cardiogenic-shock-as-health-issue–articulo-S2173572724000225

  Cardiogenic shock (CS) is a heterogeneous syndrome with high mortality and a growing incidence. It is characterized by an imbalance between the tissue oxygen demands and the capacity of the cardiovascular system to meet these demands, due to acute cardiac dysfunction. Historically, acute coronary syndromes have been the primary cause of CS. However, non-ischemic cases have seen a rise in incidence. The pathophysiology involves ischemic damage of the myocardium and a sympathetic, renin-angiotensin-aldosterone system and inflammatory response, perpetuating the situation of tissue hypoperfusion and ultimately leading to multiorgan dysfunction. […] Overall, the contribution of CS-ACS has decreased in the last two decades in parallel to an increase in CS of other etiologies. The main causes of non-ischemic CS (CS-NoACS) include non-ischemic cardiomyopathy, arrhythmias and severe valve disease. Patients with CS-NoACS have a greater burden of pre-existing heart failure, as well as atrial and ventricular arrhythmias, pulmonary hypertension and chronic kidney disease.

• #84 Cardiogenic shock as a health issue. Physiology, classification, and detection | Medicina Intensiva

  https://www.medintensiva.org/en-cardiogenic-shock-as-health-issue–articulo-S2173572724000225

  Cardiogenic shock (CS) is a heterogeneous syndrome with high mortality and a growing incidence. It is characterized by an imbalance between the tissue oxygen demands and the capacity of the cardiovascular system to meet these demands, due to acute cardiac dysfunction. Historically, acute coronary syndromes have been the primary cause of CS. However, non-ischemic cases have seen a rise in incidence. The pathophysiology involves ischemic damage of the myocardium and a sympathetic, renin-angiotensin-aldosterone system and inflammatory response, perpetuating the situation of tissue hypoperfusion and ultimately leading to multiorgan dysfunction. […] Overall, the contribution of CS-ACS has decreased in the last two decades in parallel to an increase in CS of other etiologies. The main causes of non-ischemic CS (CS-NoACS) include non-ischemic cardiomyopathy, arrhythmias and severe valve disease. Patients with CS-NoACS have a greater burden of pre-existing heart failure, as well as atrial and ventricular arrhythmias, pulmonary hypertension and chronic kidney disease.

• #85 Etiology-Specific Trends in Cardiogenic Shock From 2010 to 2020

  https://www.thecardiologyadvisor.com/news/etiology-specific-trends-in-cardiogenic-shock-from-2010-to-2020/

  Mortality related to cardiogenic shock has decreased during the past decade, but mortality related to HF-cardiogenic shock remains high. […] Cardiogenic shock can be caused by acute myocardial infarction (AMI) or heart failure (HF) and be related to ischemic cardiomyopathy (ICM) or not. […] HF-CS was associated with a higher mortality rate and greater necessity for cardiac replacement therapy compared to AMI-CS, a pattern that persisted even post-discharge and after successful recovery from CS. […] The study authors concluded, HF-CS was associated with a higher mortality rate and greater necessity for cardiac replacement therapy compared to AMI-CS, a pattern that persisted even post-discharge and after successful recovery from CS.

• #86 Etiology-Specific Trends in Cardiogenic Shock From 2010 to 2020

  https://www.thecardiologyadvisor.com/news/etiology-specific-trends-in-cardiogenic-shock-from-2010-to-2020/

  Mortality related to cardiogenic shock has decreased during the past decade, but mortality related to HF-cardiogenic shock remains high. […] Cardiogenic shock can be caused by acute myocardial infarction (AMI) or heart failure (HF) and be related to ischemic cardiomyopathy (ICM) or not. […] HF-CS was associated with a higher mortality rate and greater necessity for cardiac replacement therapy compared to AMI-CS, a pattern that persisted even post-discharge and after successful recovery from CS. […] The study authors concluded, HF-CS was associated with a higher mortality rate and greater necessity for cardiac replacement therapy compared to AMI-CS, a pattern that persisted even post-discharge and after successful recovery from CS.

• #87 Cardiogenic shock as a health issue. Physiology, classification, and detection | Medicina Intensiva

  https://www.medintensiva.org/en-cardiogenic-shock-as-health-issue–articulo-S2173572724000225

  In CS-NoACS, the index event is not so clearly identifiable. This is the case for example in cardiomyopathy with ventricular dysfunction, where a supraventricular arrhythmia, a subtle increase in congestion, or anemization can cause compensated chronic heart failure (HF) to evolve towards CS. […] In both cases (CS-ACS and CS-NoACS), the decrease in myocardial contraction capacity to below the threshold required to sustain cardiac output in accordance with the physiological demands results in changes at cardiac and systemic level that seek to maintain cardiac output. If these adjustments prove ineffective, a vicious circle is generated, leading to multiorgan failure and the death of the patient.

• #88 Cardiogenic shock as a health issue. Physiology, classification, and detection | Medicina Intensiva

  https://www.medintensiva.org/en-cardiogenic-shock-as-health-issue–articulo-S2173572724000225

  In CS-NoACS, the index event is not so clearly identifiable. This is the case for example in cardiomyopathy with ventricular dysfunction, where a supraventricular arrhythmia, a subtle increase in congestion, or anemization can cause compensated chronic heart failure (HF) to evolve towards CS. […] In both cases (CS-ACS and CS-NoACS), the decrease in myocardial contraction capacity to below the threshold required to sustain cardiac output in accordance with the physiological demands results in changes at cardiac and systemic level that seek to maintain cardiac output. If these adjustments prove ineffective, a vicious circle is generated, leading to multiorgan failure and the death of the patient.

• #89 Etiology-Specific Trends in Cardiogenic Shock From 2010 to 2020

  https://www.thecardiologyadvisor.com/news/etiology-specific-trends-in-cardiogenic-shock-from-2010-to-2020/

  Mortality related to cardiogenic shock has decreased during the past decade, but mortality related to HF-cardiogenic shock remains high. […] Cardiogenic shock can be caused by acute myocardial infarction (AMI) or heart failure (HF) and be related to ischemic cardiomyopathy (ICM) or not. […] HF-CS was associated with a higher mortality rate and greater necessity for cardiac replacement therapy compared to AMI-CS, a pattern that persisted even post-discharge and after successful recovery from CS. […] The study authors concluded, HF-CS was associated with a higher mortality rate and greater necessity for cardiac replacement therapy compared to AMI-CS, a pattern that persisted even post-discharge and after successful recovery from CS.

• #90 Cardiogenic shock – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cardiogenic-shock/symptoms-causes/syc-20366739

  Cardiogenic shock is a life-threatening condition in which your heart suddenly can’t pump enough blood to meet your body’s needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock. […] In most cases, a lack of oxygen to your heart, usually from a heart attack, damages its main pumping chamber (left ventricle). Without oxygen-rich blood flowing to that area of your heart, the heart muscle can weaken and go into cardiogenic shock. […] Rarely, damage to your heart’s right ventricle, which sends blood to your lungs to get oxygen, leads to cardiogenic shock. […] Other possible causes of cardiogenic shock include: Inflammation of the heart muscle (myocarditis), Infection of the heart valves (endocarditis), Weakened heart from any cause, Drug overdoses or poisoning with substances that can affect your heart’s pumping ability.

• #91 Cardiogenic Shock

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

  Diastolic dysfunction: Increased left ventricular diastolic chamber stiffness contributes to cardiogenic shock commonly during myocardial ischemia, but also in the late stages of hypovolemic shock and septic shock. […] Valvular dysfunction: Valvular dysfunction may lead to cardiogenic shock acutely or may aggravate other etiologies of shock. […] Cardiac arrhythmia: Ventricular tachyarrhythmias often are associated with cardiogenic shock. […] Coronary artery disease: Cardiogenic shock generally is associated with the loss of more than 40% of the left ventricular myocardium, although predominantly RV infarction or the mechanical complications of MI (eg, acute mitral regurgitation, ventricular septal rupture, free wall rupture) also may lead to cardiogenic shock. […] Other causes: Mechanical complications such as acute mitral regurgitation, large RV infarction, and rupture of the interventricular septum or left ventricular free wall are other causes of cardiogenic shock.

• #92 Cardiogenic Shock

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

  Decreased contractility, RV infarction, Ischemia, Hypoxia, Acidosis. […] Right ventricular failure, Greatly increased afterload, Pulmonary embolism, Pulmonary vascular disease, Hypoxic pulmonary vasoconstriction, Peak end-expiratory pressure, High alveolar pressure, Acute respiratory distress syndrome, Pulmonary fibrosis, Sleep disordered breathing, Chronic obstructive pulmonary disease. […] Arrhythmias, Atrial and ventricular arrhythmias, Conduction abnormalities.

• #93 What is cardiogenic shock? – Victor Chang Cardiac Research Institute

  https://www.victorchang.edu.au/heart-disease/cardiogenic-shock

  Cardiogenic shock is most commonly caused by a severe heart attack but can also occur due to other causes. […] The most common cause of cardiogenic shock is damage to the hearts main pumping chamber, the left ventricle. This damage is most often caused by a heart attack. […] However in rare cases the hearts right chamber, the right ventricle, is damaged. The right ventricle is responsible for transporting blood to the lungs to get oxygen before being sent to the rest of the body. When the right ventricle is damaged, this can also cause cardiogenic shock. […] Other conditions that may weaken the heart and cause cardiogenic shock include: inflammation of the heart muscle (myocarditis), infection of the inner lining of the hearts chambers and valves (endocarditis), an abnormal heart rhythm (arrhythmia), heart failure, chest injury, a blood clot in the lung (pulmonary embolism), weakened heart from other causes, severe cardiac valve dysfunction (usually that has happened suddenly), fluid accumulation around the heart (cardiac tamponade).

• #94 Cardiogenic Shock: Emergency Department-Focused Management – emDocs

  https://www.emdocs.net/cardiogenic-shock-emergency-department-focused-management/

  It may be helpful to categorize etiologies of CS by their underlying cause (e.g. Structure, Squeeze, and Stoppage). […] The first step in treating CS is recognizing it. A good first step in evaluating for undifferentiated shock in the emergency department is the Rapid Ultrasound for Shock and Hypotension (RUSH) exam. […] The goal of ED treatment in VSR is the reduction of afterload to decrease the left-to-right shunt. […] The pathophysiology of sepsis-induced CS is not completely understood, but it presents with some or (often) all of the following: LV dysfunction, RV dysfunction, and dilation of both ventricles. […] Sepsis-induced CS is often defined by its acute nature, absence of acute coronary syndrome (ACS), and reversibility after the primary insult is resolved. […] AMI is the primary cause for 70% of all cases of CS. CS is more likely to result from ST-elevation myocardial infarction (STEMI) than non-STEMI (NSTEMI). […] For patients with confirmed AMI causing CS, definitive care is reperfusion therapy.

• #95 Cardiogenic shock

  https://www.openaccessjournals.com/articles/cardiogenic-shock-13122.html

  The cardiogenic shock is a state of endorgan dysfunction, secondary to insufficient cardiac output despite adequate preload, as a result of left ventricular, right ventricular or biventricular dysfunction. […] Cardiogenic shock occurs in up to 10% of patients presenting with acute myocardial infarction and is the leading cause of death. […] The most common cause of cardiogenic shock is acute coronary syndrome, accounting for about 70% to 80% of cardiogenic shock cases. Other causes of cardiogenic shock predominantly include the decompensation of chronic heart failure and right ventricular failure in about 5% of cases. […] Cardiogenic shock can be caused by an acute cardiac condition or a systemic illness that triggers a chronic cardiac condition associated with minimal cardiac reserve. Unstable angina, postcardiotomy syndrome, valvular heart disease, myocardial disease (such as myo-carditis), LV outflow obstruction in hypertrophic cardiomyopathy, stress-induced cardiomyopathy, pericardial tamponade, congenital lesions, and mechanical injury to the heart have all been implicated in the pathogenesis of cardiogenic shock. […] The most common cause of cardiogenic shock during acute myocardial infarction is left ventricle failure (78.5%), followed by severe mitral regurgitation (6.9%), ventricular septal rupture (3.9%), right ventricle failure (2.8%), and cardiac tamponade (1.4%).

• #96 Cardiogenic Shock: Signs, Causes, and Treatments

  https://www.healthline.com/health/cardiogenic-shock

  Cardiogenic shock is most commonly the result of a heart attack. […] During a heart attack, the flow of blood through the arteries is restricted or blocked completely. This restriction can lead to cardiogenic shock. […] Other conditions that may cause cardiogenic shock include: sudden blockage of a blood vessel in the lung (pulmonary embolism), fluid buildup around the heart, reducing its filling capacity (pericardial tamponade), damage to the valves, allowing the backflow of blood (sudden valvular regurgitation), rupture of the wall of the heart due to increased pressure, inability of heart muscle to work properly, or at all in some cases, an arrhythmia in which the lower chambers fibrillate or quiver (ventricular fibrillation), an arrhythmia where the ventricles beat too fast (ventricular tachycardia). […] Drug overdoses can also affect the heart’s ability to pump blood and may lead to cardiogenic shock.

• #97 Acute decompensated heart failure (including cardiogenic shock) – EMCrit Project

  https://emcrit.org/ibcc/chf/

  To make things confusing, cardiogenic shock may trigger a systemic inflammatory response with elevated cytokine levels and reduced systemic vascular resistance. This may occur later in the course of cardiogenic shock, possibly due to ischemic tissue damage. […] This condition will mimic septic shock. […] Advanced-stage septic shock and advanced-stage cardiogenic shock can look clinically quite similar (e.g., shock, vasodilation, reduced systolic heart failure, systemic inflammation).

• #98 Cardiogenic shock in ACS. Part 1: prediction, presentation and medical therapy | Nature Reviews Cardiology

  https://www.nature.com/articles/nrcardio.2011.194

  Ischemic cardiogenic shock is a complex, self-perpetuating pathological process that frequently causes death irrespective of medical therapy. […] Emergence of shock depends upon the volume of ischemic myocardium, stroke volume, and peripheral vascular resistance. […] Cytokine release can trigger the systemic inflammatory response, causing low peripheral vascular resistance and profound refractory shock in around one-third of cases. […] Management of primary left ventricular failure involves early reperfusion and administration of adrenergic inotropes and vasopressors; right ventricular failure is treated with volume loading, inotropes, and pulmonary vasodilators. […] When mean arterial pressure is 55 mmHg, serum lactate 11 mmol/l, base deficit 12 mmol/l, and SvO2 65% despite medical therapy, recovery is unlikely without mechanical circulatory support.

• #99 Acute decompensated heart failure (including cardiogenic shock) – EMCrit Project

  https://emcrit.org/ibcc/chf/

  To make things confusing, cardiogenic shock may trigger a systemic inflammatory response with elevated cytokine levels and reduced systemic vascular resistance. This may occur later in the course of cardiogenic shock, possibly due to ischemic tissue damage. […] This condition will mimic septic shock. […] Advanced-stage septic shock and advanced-stage cardiogenic shock can look clinically quite similar (e.g., shock, vasodilation, reduced systolic heart failure, systemic inflammation).

• #100 Acute decompensated heart failure (including cardiogenic shock) – EMCrit Project

  https://emcrit.org/ibcc/chf/

  To make things confusing, cardiogenic shock may trigger a systemic inflammatory response with elevated cytokine levels and reduced systemic vascular resistance. This may occur later in the course of cardiogenic shock, possibly due to ischemic tissue damage. […] This condition will mimic septic shock. […] Advanced-stage septic shock and advanced-stage cardiogenic shock can look clinically quite similar (e.g., shock, vasodilation, reduced systolic heart failure, systemic inflammation).

• #101 Cardiogenic Shock – Causes and Risk Factors | NHLBI, NIH

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

  A heart attack is the most common cause of cardiogenic shock. Less often, another heart problem or a problem somewhere else in the body blocks blood flow coming into or out of the heart and leads to cardiogenic shock. […] Cardiogenic shock usually develops very quickly when it follows a heart attack. Other heart conditions, such as heart failure or arrhythmia, can make it harder for the heart to deliver oxygen-rich blood to the organs, leading to cardiogenic shock. […] Cardiogenic shock can be caused by problems outside the heart, including fluid buildup in the chest, internal bleeding or blood loss, or pulmonary embolism, which occurs when a blood clot gets stuck in an artery of the lung. […] Rarely, some medicines can cause cardiogenic shock if you take a dose that is too high, or if your heart is not working well after a heart attack or other heart problem. […] The main cause of cardiogenic shock is a heart attack, which is a complication of coronary heart disease. […] Certain factors may increase your risk for cardiogenic shock. […] Cardiogenic shock may be more common in women than men.

• #102 Cardiogenic Shock – CVRTI

  https://cvrti.utah.edu/cardiogenic-shock/

  Cardiogenic shock often occurs when someone is having acute myocardial infarction (AMI), also known as a heart attack. […] The most common cause of cardiogenic shock is a severe heart attack. While a person is experiencing a heart attack, their ventricle (most often the left ventricle) is damaged, causing the body to lose the ability to pump blood, thus sending the patient into shock. […] There are a few other causes of cardiogenic shock in addition to heart attacks of patients including: Heart Failure or Arrhythmia, Fluid buildup in chest, internal bleeding, pulmonary embolism, Some medications including beta blockers or calcium channel blockers (however, this is very rare). […] There are several risk factors attributed with a higher chance of developing cardiogenic shock including age, a history of heart failure or heart attack, having diabetes or high blood pressure, and being a female.

• #103 Cardiogenic Shock – Causes and Risk Factors | NHLBI, NIH

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

  A heart attack is the most common cause of cardiogenic shock. Less often, another heart problem or a problem somewhere else in the body blocks blood flow coming into or out of the heart and leads to cardiogenic shock. […] Cardiogenic shock usually develops very quickly when it follows a heart attack. Other heart conditions, such as heart failure or arrhythmia, can make it harder for the heart to deliver oxygen-rich blood to the organs, leading to cardiogenic shock. […] Cardiogenic shock can be caused by problems outside the heart, including fluid buildup in the chest, internal bleeding or blood loss, or pulmonary embolism, which occurs when a blood clot gets stuck in an artery of the lung. […] Rarely, some medicines can cause cardiogenic shock if you take a dose that is too high, or if your heart is not working well after a heart attack or other heart problem. […] The main cause of cardiogenic shock is a heart attack, which is a complication of coronary heart disease. […] Certain factors may increase your risk for cardiogenic shock. […] Cardiogenic shock may be more common in women than men.

• #104 Cardiogenic Shock – CVRTI

  https://cvrti.utah.edu/cardiogenic-shock/

  Cardiogenic shock often occurs when someone is having acute myocardial infarction (AMI), also known as a heart attack. […] The most common cause of cardiogenic shock is a severe heart attack. While a person is experiencing a heart attack, their ventricle (most often the left ventricle) is damaged, causing the body to lose the ability to pump blood, thus sending the patient into shock. […] There are a few other causes of cardiogenic shock in addition to heart attacks of patients including: Heart Failure or Arrhythmia, Fluid buildup in chest, internal bleeding, pulmonary embolism, Some medications including beta blockers or calcium channel blockers (however, this is very rare). […] There are several risk factors attributed with a higher chance of developing cardiogenic shock including age, a history of heart failure or heart attack, having diabetes or high blood pressure, and being a female.

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

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

  Cardiogenic shock can result from a heart attack or other issues of the heart. […] The National Heart, Lung, and Blood Institute (NHLBI) state that a heart attack is the most common cause of cardiogenic shock but not the only cause. They note that other possible causes include: heart failure, chest injuries, certain medications, such as calcium channel blockers, although this is rare, blood clots, fluid buildup in the chest, internal bleeding, blood loss, pulmonary embolism, rare complications from procedures in the heart. […] Cardiogenic shock is more common in males than in females. Furthermore, Asian American people and Pacific Islanders have a higher risk of cardiogenic shock than those belonging to other ethnic groups.

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

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

  Cardiogenic shock can result from a heart attack or other issues of the heart. […] The National Heart, Lung, and Blood Institute (NHLBI) state that a heart attack is the most common cause of cardiogenic shock but not the only cause. They note that other possible causes include: heart failure, chest injuries, certain medications, such as calcium channel blockers, although this is rare, blood clots, fluid buildup in the chest, internal bleeding, blood loss, pulmonary embolism, rare complications from procedures in the heart. […] Cardiogenic shock is more common in males than in females. Furthermore, Asian American people and Pacific Islanders have a higher risk of cardiogenic shock than those belonging to other ethnic groups.

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

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

  The principal element of the primary evaluation is the awareness and investigation of potential causes of circulatory compromise. Practitioners should follow a focused algorithm denoted by the CHAMPIT acronym (C indicating ACS; H, Hypertension emergency; A, Arrhythmia; M, Mechanical cause; P, Pulmonary embolism; I, Infection; and T, cardiac Tamponade). Reversible causes of CS necessitate prompt identification and management, particularly ACS whose prognosis is significantly correlated with an immediate reperfusion strategy. […] 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.

• #108

  https://step2.medbullets.com/cardiovascular/120760/cardiogenic-shock

  Imaging: Echocardiography […] indication […] identify etiology of cardiogenic shock. […] Studies: Electrocardiography (ECG) […] indication […] identify etiology of cardiogenic shock. […] Diagnosis: Making the diagnosis […] most cases are clinically diagnosed. […] Management approach: always assess the ABCs airway, breathing, and circulation […] identify and treat the underlying cause (e.g., revascularization in the case of myocardial infarction-induced cardiogenic shock).

• #109

  https://step2.medbullets.com/cardiovascular/120760/cardiogenic-shock

  Imaging: Echocardiography […] indication […] identify etiology of cardiogenic shock. […] Studies: Electrocardiography (ECG) […] indication […] identify etiology of cardiogenic shock. […] Diagnosis: Making the diagnosis […] most cases are clinically diagnosed. […] Management approach: always assess the ABCs airway, breathing, and circulation […] identify and treat the underlying cause (e.g., revascularization in the case of myocardial infarction-induced cardiogenic shock).

• #110

  https://step2.medbullets.com/cardiovascular/120760/cardiogenic-shock

  Imaging: Echocardiography […] indication […] identify etiology of cardiogenic shock. […] Studies: Electrocardiography (ECG) […] indication […] identify etiology of cardiogenic shock. […] Diagnosis: Making the diagnosis […] most cases are clinically diagnosed. […] Management approach: always assess the ABCs airway, breathing, and circulation […] identify and treat the underlying cause (e.g., revascularization in the case of myocardial infarction-induced cardiogenic shock).

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

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

  The principal element of the primary evaluation is the awareness and investigation of potential causes of circulatory compromise. Practitioners should follow a focused algorithm denoted by the CHAMPIT acronym (C indicating ACS; H, Hypertension emergency; A, Arrhythmia; M, Mechanical cause; P, Pulmonary embolism; I, Infection; and T, cardiac Tamponade). Reversible causes of CS necessitate prompt identification and management, particularly ACS whose prognosis is significantly correlated with an immediate reperfusion strategy. […] 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.

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

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

  The principal element of the primary evaluation is the awareness and investigation of potential causes of circulatory compromise. Practitioners should follow a focused algorithm denoted by the CHAMPIT acronym (C indicating ACS; H, Hypertension emergency; A, Arrhythmia; M, Mechanical cause; P, Pulmonary embolism; I, Infection; and T, cardiac Tamponade). Reversible causes of CS necessitate prompt identification and management, particularly ACS whose prognosis is significantly correlated with an immediate reperfusion strategy. […] 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.

• #113 Cardiogenic Shock: Emergency Department-Focused Management – emDocs

  https://www.emdocs.net/cardiogenic-shock-emergency-department-focused-management/

  It may be helpful to categorize etiologies of CS by their underlying cause (e.g. Structure, Squeeze, and Stoppage). […] The first step in treating CS is recognizing it. A good first step in evaluating for undifferentiated shock in the emergency department is the Rapid Ultrasound for Shock and Hypotension (RUSH) exam. […] The goal of ED treatment in VSR is the reduction of afterload to decrease the left-to-right shunt. […] The pathophysiology of sepsis-induced CS is not completely understood, but it presents with some or (often) all of the following: LV dysfunction, RV dysfunction, and dilation of both ventricles. […] Sepsis-induced CS is often defined by its acute nature, absence of acute coronary syndrome (ACS), and reversibility after the primary insult is resolved. […] AMI is the primary cause for 70% of all cases of CS. CS is more likely to result from ST-elevation myocardial infarction (STEMI) than non-STEMI (NSTEMI). […] For patients with confirmed AMI causing CS, definitive care is reperfusion therapy.

• #114

  https://journals.lww.com/co-criticalcare/fulltext/2021/08000/epidemiology_and_causes_of_cardiogenic_shock.12.aspx

  Cardiogenic shock is a complex clinical syndrome of end-organ hypoperfusion due to impaired cardiac performance. Although cardiogenic shock has traditionally been viewed as a monolithic disorder predominantly caused by severe left ventricular dysfunction complicating acute myocardial infarction (AMI), there is increasing recognition of the diverse causes of cardiogenic shock and wide spectrum of clinical severity. […] The proportion of cardiogenic shock cases related to AMI has decreased over time to 30%, while the proportion of cardiogenic shock cases due to acute decompensated heart failure has steadily increased.

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

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

  Cardiogenic shock (CS) represents a life-threatening condition equated to a dismal prognosis. Since the introduction of the fundamental mechanisms of shock in 1972, CS has been universally defined as a state of severe end-organ hypoperfusion and tissue hypoxia resulting primarily from cardiac pump failure. Epidemiological data over the last decade report a significant increase in the incidence rate of hospitalizations, while in-hospital mortality has not shown any significant improvement. Traditionally, acute coronary syndrome (ACS) has been the leading cause of CS, accounting for approximately 80% of cases. However, recent observational studies report a declining incidence of ACS-CS, ranging from 30 to 55.4%, with a concurrent increase in the incidence of CS of other etiologies, mainly decompensated heart failure (AHF-CS).

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

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

  The principal element of the primary evaluation is the awareness and investigation of potential causes of circulatory compromise. Practitioners should follow a focused algorithm denoted by the CHAMPIT acronym (C indicating ACS; H, Hypertension emergency; A, Arrhythmia; M, Mechanical cause; P, Pulmonary embolism; I, Infection; and T, cardiac Tamponade). Reversible causes of CS necessitate prompt identification and management, particularly ACS whose prognosis is significantly correlated with an immediate reperfusion strategy. […] 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.

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

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

  Therapeutic decision-making, and appropriate drug and device selection are influenced by pre-shock cardiovascular state, extracardiac comorbidities, shock etiology and phenotype, severity of illness, and the presence or absence of concomitant respiratory failure and/or cardiac arrest. […] Shock states often encompass intersecting acute MI, acute decompensated heart failure, post-cardiotomy, pulmonary embolism, cardiac arrest, and valvular heart disease-related entities with etiology-specific risk-related classifications and invasive hemodynamic profiles. Understanding the relationships between disease acuity and severity, hemodynamic phenotypes, age, extracardiac organ involvement, and underlying comorbidities and pre-existing chronic illness, while challenging, is key to successful management. […] Five key treatment objectives have been increasingly promoted in the acute management of CS: circulatory support, ventricular support, myocardial perfusion, decongestion, and prevention and management of extracardiac critical illness.

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