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Cardiogenic shock and pulmonary edema are life-threatening conditions that should be treated as medical emergencies. The most common joint etiology is severe left ventricular (LV) dysfunction that leads to pulmonary congestion and/or systemic hypoperfusion (Fig. 34-1). The pathophysiology of pulmonary edema is discussed in Chap. 5.
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Cardiogenic shock (CS) is characterized by systemic hypoperfusion due to severe depression of the cardiac index (<2.2 [L/min]/m2) and sustained systolic arterial hypotension (<90 mmHg) despite an elevated filling pressure (pulmonary capillary wedge pressure [PCWP] >18 mmHg). It is associated with in-hospital mortality rates >50%. The major causes of CS are listed in Table 34-1. Circulatory failure based on cardiac dysfunction may be caused by primary myocardial failure, most commonly secondary to acute myocardial infarction (MI) (Chap. 41), and less frequently by cardiomyopathy or myocarditis (Chap. 27), cardiac tamponade (Chap. 28), or critical valvular heart disease (Chap. 23).
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