Clinical manifestations and diagnosis of cardiogenic shock in acute myocardial infarction
- Judith S Hochman, MD
Judith S Hochman, MD
- Harold Snyder Family Professor of Cardiology
- New York University School of Medicine
- Alex Reyentovich, MD
Alex Reyentovich, MD
- Assistant Professor of Medicine
- NYU Langone School of Medicine
Cardiogenic shock is a clinical condition of inadequate tissue (end-organ) perfusion due to the inability of the heart to pump an adequate amount of blood. The reduction in tissue perfusion results in decreased oxygen and nutrient delivery to the tissues and, if prolonged, potentially end-organ damage and multi-system failure. (See "Definition, classification, etiology, and pathophysiology of shock in adults", section on 'Introduction'.)
Acute myocardial infarction (MI) is the most common cause of cardiogenic shock and is defined as a clinical event consequent to the death of cardiac myocytes (myocardial necrosis) that is caused by ischemia (as opposed to other etiologies such as myocarditis or trauma). (See "Criteria for the diagnosis of acute myocardial infarction", section on 'Acute MI'.)
Cardiogenic shock is the leading cause of death in patients with acute MI, with hospital mortality rates approaching 50 percent . Short-term prognosis is directly related to the severity of the hemodynamic disorder. The clinical manifestations and diagnosis of cardiogenic shock in acute MI will be reviewed here. The prognosis and treatment are discussed separately. (See "Prognosis and treatment of cardiogenic shock complicating acute myocardial infarction".)
An overview of the types of shock in adults and the diagnostic approach to such patients is presented separately. (See "Definition, classification, etiology, and pathophysiology of shock in adults".)
All forms of shock, including hypovolemic and distributive, are characterized by relatively low blood pressure and manifestations of end-organ hypoperfusion, such as poor mentation or low urine output. Patients with cardiogenic shock have a low cardiac index (<2.2 L/min/m2), elevated filling pressures of the left, right, or both ventricles, and a decreased mixed venous oxygen saturation (table 1) [2-4]. The systemic vascular resistance is often high, but it may be in the normal or low range. Individuals with normal or low range of systemic vascular resistance represent a group of patients with more profound hypoperfusion and inflammatory response and associated worse prognosis .
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- Contributing factors
- RISK FACTORS
- CLINICAL PRESENTATION
- History and physical examination
- Laboratory findings
- Time of onset
- Hemodynamic monitoring
- Coronary angiography and ventriculography
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS