Cardiogenic shock is the primary cause of hospital death after myocardial infarction. Several conditions must be distinguished from left ventricular power failure as the etiology of hypotension accompanying myocardial infarction. Multivessel coronary artery disease effects abnormal function of regions remote from the infarct segment and plays a major role in the pathophysiology of cardiogenic shock.
Aggressive management of cardiogenic shock includes concomitant diagnostic and therapeutic measures. Identification of predictive indicators may allow early preventative actions. Pharmacologic and mechanical supportive maneuvers are necessary adjuncts. In patients with ventricular septal defect or papillary muscle rupture, early operative correction is necessary to impact the poor overall outcome of these mechanical defects.
The survival benefit of early infarct artery reperfusion in acute myocardial infarction appears to extend to the subset with cardiogenic shock. Transluminal revascularization and coronary artery bypass surgery appear to be superior to thrombolytic therapy in effecting infarct artery patency in this hemodynamic subset.
Despite increased understanding and therapeutic promise, cardiogenic shock remains an ominous diagnosis. The revascularization strategy for cardiogenic shock will continue to evolve. The role of metabolic myocardial support, mitigation of reperfusion injury, and newer circulatory support devices must also be clarified.
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