Background: Cardiogenic shock is a major, and frequently fatal, complication of
a variety of acute and chronic disorders that impair the ability of the heart to
maintain adequate tissue perfusion. Cardiac failure with cardiogenic shock
continues to be a frustrating clinical problem; the management of this condition
requires a rapid and well-organized approach.
Cardiogenic shock is a physiologic state in which inadequate tissue perfusion
results from cardiac dysfunction, most commonly following acute myocardial
infarction (MI). The clinical definition of cardiogenic shock is decreased cardiac
output and evidence of tissue hypoxia in the presence of adequate intravascular
volume. Hemodynamic criteria for cardiogenic shock are sustained hypotension
(systolic blood pressure <90 mm Hg for at least 30 min) and a reduced cardiac
index (<2.2 L/min/m2) in the presence of elevated pulmonary capillary occlusion
pressure (>15 mm Hg).
The diagnosis of cardiogenic shock can sometimes be made at the bedside by
observing hypotension and clinical signs of poor tissue perfusion, which include
oliguria, cyanosis, cool extremities, and altered mentation. These signs usually
persist after attempts have been made to correct hypovolemia, arrhythmia,
hypoxia, and acidosis.
(
geocities.com/yale_er_doc)