Management of Cardiogenic Shock: Focus on Tissue Perfusion

Cardiogenic shock (CS) may result from ischemic heart disease, cardiomyopathy, valvular heart disease, inflammation, myocardial contusion, and cardiac surgery. CS is the leading cause of in-hospital death in patients with acute myocardial infarction. Although early revascularization strategies have resulted in a better prognosis, in-hospital mortality from CS remains exceptionally high. Notably, long-term annual mortality is similar in survivors of CS relative to patients with myocardial infarction without shock. This underlines the importance of aggressive support of the failing heart in the acute phase of CS. Because CS reflects a state of hypoperfusion induced by heart failure, management of CS should aim at improving cardiac function as well as at optimization of tissue perfusion. This review evaluates the current treatment of CS. In addition, novel approaches to monitor and modulate peripheral circulation at the bedside are highlighted. It is expected that these techniques will improve our understanding of the pathogenesis of CS and will offer new opportunities to guide therapy in CS patients to improve long-term prognosis. (Curr Probl Cardiol 2009;34:330-349.)