Diagnosis and management of cardiogenic shock.

PURPOSE OF REVIEW: Cardiogenic shock continues to portend a poor prognosis. Despite ongoing efforts over the past few decades to help improve mortality, little progress has been made in improving the short-term and long-term outcomes of patients presenting with cardiogenic shock. This is especially true of those presenting with acute myocardial infarct related cardiogenic shock.

RECENT FINDINGS: Cardiogenic shock should be understood as a continuum. Patients can move from one stage of shock to another and hence should be assessed on an ongoing basis. Cardiogenic shock should be assessed based on the severity, the phenotypic presentation and the concomitant processes that influence prognosis. Right ventricular cardiogenic shock and mixed cardiogenic shock have been recognized as predictors of worse overall prognosis. Incorporating detailed classification of cause of cardiogenic shock into routine clinical practice and will help with standardizing nomenclature and aid in understanding of the disease process and assist in refining interventions.

SUMMARY: Early identification, risk stratification and understanding the nuances of presentation may help with selecting appropriate treatment strategies. Aggressive management should include multidisciplinary team-based approaches to help escalate care as needed.