When the Pump Fails: Cardiogenic Shock

• Suspect cardiogenic shock when cardiac dysfunction causes tissue hypoperfusion, with or without sustained SBP <90 mm Hg; congestion and filling pressures vary by phenotype.
• Obtain an ECG and urgent bedside echocardiography while stabilizing the patient. A nondiagnostic ECG does not exclude acute coronary syndrome or another cardiac cause.
• Use norepinephrine for severe hypotension and an inotrope for demonstrated low output when needed. Give only a cautious fluid challenge when preload is inadequate and congestion is absent.
• Acute-MI shock needs urgent culprit-vessel revascularization. Use temporary mechanical circulatory support selectively through a shock team; routine IABP and routine early VA-ECMO are not recommended.

First tests: 12-lead ECG, Bedside echocardiography, High-sensitivity cardiac troponin, Blood lactate, Sodium, potassium, bicarbonate, urea and creatinine, Full blood count.

Only if indicated: Coronary angiography, Invasive hemodynamic assessment, Chest X-ray.

Repeat monitoring: Blood lactate, Sodium, potassium, bicarbonate, urea and creatinine.

• Mechanisms of Cardiogenic Shock
• Managing Suspected Cardiogenic Shock