TY - CHAP M1 - Book, Section TI - Circulatory and Cardiogenic Shock A1 - Serrao, Gregory A1 - Bier, Benjamin A1 - Gidwani, Umesh A2 - Fuster, Valentin A2 - Narula, Jagat A2 - Vaishnava, Prashant A2 - Leon, Martin B. A2 - Callans, David J. A2 - Rumsfeld, John S. A2 - Poppas, Athena PY - 2022 T2 - Fuster and Hurst's The Heart, 15e AB - Chapter SummaryThis chapter describes the pathophysiology, assessment, classification, and management of cardiogenic shock (see Fuster and Hurst’s Central Illustration). The pathophysiology of cardiogenic shock involves a maladaptive compensatory cycle triggered by acute reduction in cardiac output. All etiologies initiate a physiologic cascade rooted in three main pathways: (1) increase in left ventricular end diastolic pressure, (2) reduction of blood pressure, and (3) triggering of inflammatory responses. If left uninterrupted, the compensatory cycle will lead to progressive cardiac dysfunction and ultimately death. A thorough assessment of the patient with suspected cardiogenic shock is necessary to confirm diagnosis and inform treatment decisions, and involves physical examination, ultrasonography, laboratory studies, invasive hemodynamics, and coronary angiography, as appropriate. Cardiogenic shock with predominant left ventricular failure is more common than isolated right ventricular failure, and etiology can be categorized as primary, obstructive, or valvular. Etiology of cardiogenic shock with predominant right ventricular failure is usually primary or obstructive, often related to acute pulmonary embolism of hemodynamic significance. Concurrent left ventricular failure and right ventricular failure is relatively common among causes of cardiogenic shock and the underlying etiology is primary, obstructive, electrical, or structural. Treatment for cardiogenic shock depends on etiology, and may involve a combination of vasoactive agents (pressors and inotropes), treatment of myocardial ischemia and revascularization as appropriate, and mechanical circulatory support (e.g. intra-aortic balloon pump counterpulsation, percutaneous left ventricular assist device, and/or extracorporal membrane oxygenation) as needed. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/14 UR - accesscardiology.mhmedical.com/content.aspx?aid=1202456766 ER -