Cardiogenic shock - Revision history

Danbot: Add verified PubMed references (PMIDs 37973356, 33121700)

2026-03-22T10:43:37Z

Add verified PubMed references (PMIDs 37973356, 33121700)

← Older revision		Revision as of 10:43, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*Leading cause of death in patients with [[ACS]] who reach the hospital alive		*Leading cause of death in patients with [[ACS]] who reach the hospital alive<ref>Sarma D, Jentzer JC. Cardiogenic Shock: Pathogenesis, Classification, and Management. Crit Care Clin. 2024 Jan;40(1):37-56. PMID 37973356</ref>

	===Etiologies===		===Etiologies===
	*[[Myocardial infarction]]		*[[Myocardial infarction]]
	**Pump failure		**Pump failure
	**Mechanical complications		**Mechanical complications<ref>Tehrani BN, et al. A Standardized and Comprehensive Approach to the Management of Cardiogenic Shock. JACC Heart Fail. 2020 Nov;8(11):879-891. PMID 33121700</ref>
	**Acute [[mitral regurgitation]] (papillary muscle rupture)		**Acute [[mitral regurgitation]] (papillary muscle rupture)
	**[[VSD]]		**[[VSD]]

Rossdonaldson1: /* Video */

2024-04-17T20:16:10Z

Video

← Older revision		Revision as of 20:16, 17 April 2024
Line 108:		Line 108:
	*[http://emcrit.org/podcasts/cardiogenic-shock/ EMCrit Podcast – Cardiogenic Shock]		*[http://emcrit.org/podcasts/cardiogenic-shock/ EMCrit Podcast – Cardiogenic Shock]
	*[http://www.emdocs.net/diagnosing-cardiogenic-shock-in-the-ed/ emDocs - Diagnosing Cardiogenic Shock in the ED]		*[http://www.emdocs.net/diagnosing-cardiogenic-shock-in-the-ed/ emDocs - Diagnosing Cardiogenic Shock in the ED]

	~~==Video==~~
	~~{{#widget:YouTube\|id=GTZ8Zh8jPxA}}~~

	==References==		==References==

Vid: /* Etiologies */

2021-09-08T12:03:23Z

Etiologies

← Older revision		Revision as of 12:03, 8 September 2021
Line 26:		Line 26:
	**Chordal rupture		**Chordal rupture
	**[[Aortic Insufficiency]]		**[[Aortic Insufficiency]]
			*Toxic/metabolic
			**Severe [[acidosis]], severe hypoxemia

	==Clinical Features==		==Clinical Features==
Line 45:		Line 47:
	**Lactate		**Lactate
	**CBC		**CBC
			***WBC elevated with a left shift
	**Chem		**Chem
	**LFTs		**LFTs
			***elevated due to liver hypoperfusion
			**[[ABG]]
			***[[anion gap acidosis]]
	**[[BNP]]		**[[BNP]]
	*[[ECG]]		*[[ECG]]

Mholtz: /* General */

2021-07-01T03:52:15Z

General

← Older revision		Revision as of 03:52, 1 July 2021
Line 57:		Line 57:
	===General===		===General===
	''Aim for MAP >65''		''Aim for MAP >65''
	#Consider etiologies (see above) and treat specific one, if present		*Consider etiologies (see above) and treat specific one, if present
	#Consider small fluid challenge (250-500cc normal saline IV) or fluid removal, depending on estimation of patient's point on Starling curve		*Consider small fluid challenge (250-500cc normal saline IV) or fluid removal, depending on estimation of patient's point on Starling curve
	#Increase inotropy		*Increase inotropy
	#*[[Dobutamine]] +/- [[norepinephrine]] '''OR''' [[dopamine]]		**[[Dobutamine]] +/- [[norepinephrine]] '''OR''' [[dopamine]]
	#**[[Dobutamine]] may initially drop pressures, so may need to use second agent to maintain BP		***[[Dobutamine]] may initially drop pressures, so may need to use second agent to maintain BP
	#**Consider [[milrinone]] or [[beta-blocker toxicity\|beta-blocker reversal]] if patient is on a [[beta-blocker]]		**Consider [[milrinone]] or [[beta-blocker toxicity\|beta-blocker reversal]] if patient is on a [[beta-blocker]]
	#*Consider [[calcium chloride]] 1 g if hypocalcemic or normocalcemic through good PIV or central line		**Consider [[calcium chloride]] 1 g if hypocalcemic or normocalcemic through good PIV or central line
	#Consider [[transfusion]] if hemoglobin < 10 (be aware of added fluid)		*Consider [[transfusion]] if hemoglobin < 10 (be aware of added fluid)
	#Consider [[intubation]]		*Consider [[intubation]]
	#*Decreases O2 demand BUT may worsen preload		**Decreases O2 demand BUT may worsen preload

	===Specific Situations===		===Specific Situations===

Blsimpso: /* External Links */

2021-07-01T02:11:04Z

External Links

← Older revision		Revision as of 02:11, 1 July 2021
Line 101:		Line 101:
	==External Links==		==External Links==
	*[http://emcrit.org/podcasts/cardiogenic-shock/ EMCrit Podcast – Cardiogenic Shock]		*[http://emcrit.org/podcasts/cardiogenic-shock/ EMCrit Podcast – Cardiogenic Shock]
			*[http://www.emdocs.net/diagnosing-cardiogenic-shock-in-the-ed/ emDocs - Diagnosing Cardiogenic Shock in the ED]

	==Video==		==Video==

ClaireLewis: /* Etiologies */

2019-09-27T15:14:49Z

Etiologies

← Older revision		Revision as of 15:14, 27 September 2019
Line 8:		Line 8:
	**Acute [[mitral regurgitation]] (papillary muscle rupture)		**Acute [[mitral regurgitation]] (papillary muscle rupture)
	**[[VSD]]		**[[VSD]]
	**Free-wall rupture		**[[cardiac rupture\|Free-wall rupture]]
	*RV infarction		*RV infarction
	*Decreased forward flow		*Decreased forward flow
Line 17:		Line 17:
	**[[Myocarditis]]		**[[Myocarditis]]
	**[[Myocardial contusion]]		**[[Myocardial contusion]]
	**Cardiomyopathy		**[[Cardiomyopathy]]
	*Mechanical obstruction to forward flow		*Mechanical obstruction to forward flow
	**[[Aortic stenosis]]		**[[Aortic stenosis]]
	**[[HOCM]]		**[[HOCM]]
	**[[Mitral stenosis]]		**[[Mitral stenosis]]
	**Pericardial		**[[pericardial effusion\|Pericardial]]
	*LV regurgitation		*LV regurgitation
	**Chordal rupture		**Chordal rupture

ClaireLewis: /* Workup */

2019-09-24T03:17:43Z

Workup

← Older revision		Revision as of 03:17, 24 September 2019
Line 50:		Line 50:
	*[[ECG]]		*[[ECG]]
	*[[CXR]]		*[[CXR]]
	*TTE		*[[Echocardiography\|TTE]]

	{{BNP value}}		{{BNP value}}

Gregtong: /* Workup */

2019-08-16T04:49:00Z

Workup

← Older revision		Revision as of 04:49, 16 August 2019
Line 46:		Line 46:
	**CBC		**CBC
	**Chem		**Chem
			**LFTs
	**[[BNP]]		**[[BNP]]
	*[[ECG]]		*[[ECG]]

ClaireLewis: /* Etiologies */

2017-08-31T21:38:20Z

Etiologies

← Older revision		Revision as of 21:38, 31 August 2017
Line 6:		Line 6:
	**Pump failure		**Pump failure
	**Mechanical complications		**Mechanical complications
	**Acute MR (papillary muscle rupture)		**Acute [[mitral regurgitation]] (papillary muscle rupture)
	**VSD		**[[VSD]]
	**Free-wall rupture		**Free-wall rupture
	*RV infarction		*RV infarction
Line 13:		Line 13:
	**[[Sepsis]]		**[[Sepsis]]
	**Rate-related		**Rate-related
	***Bradycardia		***[[Bradycardia]]
	***Tachycardia		***[[Tachycardia]]
	**[[Myocarditis]]		**[[Myocarditis]]
	**[[Myocardial contusion]]		**[[Myocardial contusion]]
Line 25:		Line 25:
	*LV regurgitation		*LV regurgitation
	**Chordal rupture		**Chordal rupture
	**Aortic ~~insufficiency~~		**[[Aortic Insufficiency]]

	==Clinical Features==		==Clinical Features==

Mholtz: Text replacement - "OR" to "'''OR'''"

2017-05-30T23:30:49Z

Text replacement - "OR" to "'''OR'''"

← Older revision		Revision as of 23:30, 30 May 2017
Line 59:		Line 59:
	#Consider small fluid challenge (250-500cc normal saline IV) or fluid removal, depending on estimation of patient's point on Starling curve		#Consider small fluid challenge (250-500cc normal saline IV) or fluid removal, depending on estimation of patient's point on Starling curve
	#Increase inotropy		#Increase inotropy
	#*[[Dobutamine]] +/- [[norepinephrine]] OR [[dopamine]]		#*[[Dobutamine]] +/- [[norepinephrine]] '''OR''' [[dopamine]]
	#**[[Dobutamine]] may initially drop pressures, so may need to use second agent to maintain BP		#**[[Dobutamine]] may initially drop pressures, so may need to use second agent to maintain BP
	#**Consider [[milrinone]] or [[beta-blocker toxicity\|beta-blocker reversal]] if patient is on a [[beta-blocker]]		#**Consider [[milrinone]] or [[beta-blocker toxicity\|beta-blocker reversal]] if patient is on a [[beta-blocker]]