Review
The comparative epidemiology, pathophysiology and management of cardiogenic shock associated with acute myocardial infarction and advanced heart failure
Canadian journal of cardiology, v 41(4)
30 Jan 2025
PMID: 39892612
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Cardiogenic shock (CS) results from low cardiac output due to myocardial dysfunction coupled with systemic end-organ tissue hypoperfusion and elevated ventricular filling pressures along a spectrum of shock severity. This narrative review aims to compare the epidemiology, pathophysiology and contemporary management of two common etiologies of CS due to acute myocardial infarction (AMI-CS) and advanced heart failure (HF-CS). CS complicates up to 14% of AMI and 5% of HF admissions. Rapid therapeutic intervention after prompt recognition of CS etiology is the mainstay towards improving clinical outcomes and mitigating end-organ sequelae and death. In AMI-CS, persistent hypotension often leads to subsequent hypoperfusion and congestion, and early culprit coronary artery lesion revascularization is critical. In HF-CS, congestion often precedes hypoperfusion and hypotension, and targeting the underlying non-ischemic cause of myocardial dysfunction is key. Tailoring of hemodynamic strategies with vasoactive agents and temporary mechanical circulatory and end-organ support to manage the predominant ventricular failure, hemo-metabolic phenotypes, and shock severity associated with each etiology are discussed. Given the limited evidence-base in CS care, we also highlight potential knowledge gaps ripe for future exploration.
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Details
- Title
- The comparative epidemiology, pathophysiology and management of cardiogenic shock associated with acute myocardial infarction and advanced heart failure
- Creators
- Varinder K Randhawa - University of TorontoDavid A Baran - Cleveland Clinic FloridaManreet K Kanwar - Allegheny Health NetworkJaime A Hernandez-Montfort - Baylor Scott & White HealthShashank S Sinha - Inova Fairfax HospitalChristopher F Barnett - University of California, San FranciscoFilio Billia - University Health Network
- Publication Details
- Canadian journal of cardiology, v 41(4)
- Publisher
- Elsevier
- Number of pages
- 14
- Resource Type
- Review
- Language
- English
- Academic Unit
- Cardiology
- Web of Science ID
- WOS:001469399100001
- Scopus ID
- 2-s2.0-105000712366
- Other Identifier
- 991022024209704721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems