New treatment strategies for cardiogenic shock in acute MI. Management options depend on the availability of a cath lab.

Aggressive treatment strategies that include early revascularization may significantly improve survival from acute MI complicated by cardiogenic shock. Symptoms of impending cardiogenic shock include tachycardia, cool extremities, pallor, cyanosis, and a normal or low blood pressure. When possible, the right and left sides of the heart are catheterized immediately. For patients who need to be transferred to a hospital with a catheterization laboratory, use temporary support measures--intubation, administration of positive inotropic agents, and placement of an intra-aortic balloon pump. Coronary angiography can reveal whether direct PTCA or bypass surgery is appropriate. Thrombolysis is limited to patients for whom transfer is delayed and those in whom cardiogenic shock is ruled out.