Cardiogenic shock is profound circulatory failure, usually due to cumulative myocardial loss of 40% or more. Cardiogenic shock is most often secondary to acute myocardial infarction, but other etiologies exist which include primary myocardial disease (myocarditis or end-stage cardiomyopathy).
Clinical findings Peak systolic blood pressure of 90 mmHg
Peripheral vasoconstriction with cool, clammy, and often cyanotic skin
Oliguria or anuria
Altered mental status (confusion, lethargy, obtundation, coma)
Persistence of shock after correction of contributory factors (e.g., hypovolemia, drug side effect or toxicity, arrhythmias, acid-base imbalance)
Hemodynamic findings Low cardiac index of 1.8 L/min/m2 Blood pressure of 90 mmHg systolic and 60 mmHg diastolic Elevated pulmonary capillary wedge pressure of 18 mmHg Tachycardia
Increased systemic vascular resistance Low stroke volume index of 20 ml/m2.
Can cardiogenic shock be predicted?
Approximately 7-9% of patients admitted with acute MI develop cardiogenic shock. The average time from admission to onset of this complication is 3.4 + 0.8 days. The following factors, present at the time of admission, are related to the inhospital development of cardiogenic shock:
The probability for development of cardiogenic shock depends on the number of these factors present: when 3 are present, there is an 18% probability of shock, and when 5 are present, it is 54%.