Cardiogenic Shock

Cardiogenic shock is a life-threatening state of inadequate tissue perfusion caused by severe cardiac dysfunction. The key is to recognize low-output physiology, support perfusion, and rapidly identify the underlying cause.

In this episode, Chris and Mars review:

• The classic hemodynamic pattern of cardiogenic shock
• How to distinguish cardiogenic shock from septic, hypovolemic, and obstructive shock
• Why cool extremities, elevated jugular venous pressure, pulmonary edema, oliguria, and rising lactate matter
• Norepinephrine as the preferred first-line vasopressor for hypotensive cardiogenic shock
• When to add an inotrope such as dobutamine or milrinone
• Why large fluid boluses can worsen left-sided cardiogenic shock
• Myocardial infarction as a major cause and the importance of emergency reperfusion
• Post-MI mechanical complications including papillary muscle rupture, ventricular septal rupture, and free wall rupture
• When persistent shock should prompt invasive hemodynamic assessment and consideration of temporary mechanical circulatory support

Episode pearl: Support the pressure with norepinephrine, support cardiac output with an inotrope when needed, and always treat the cause of the shock.

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