Update on the management of cardiogenic shock

Purpose of review Cardiogenic shock is a life threatening emergency that occurs frequently with acute coronary syndromes. If rapid myocardial reperfusion following acute myocardial infarction is not obtained either with thrombolytics or by revascularization, cardiogenic shock frequently develops and the mortality rate is high. This review summarized recent advances in the pathophysiology, incidence and treatment of cardiogenic shock. Particular attention is given to pharmacologic advances. Recent findings Cardiogenic shock continues to occur in 5-10% of patients who suffer a myocardial infarction and the mortality remains over 50% inmost studies. Treatment preference is referral to a cardiac center capable of reperfusion using multiple therapies. While no delay in reperfusion is acceptable, emphasis on implementing supportive treatment such as vasopressors, inotropes,and fluids remains critical. There is a wide variance in treatment standards despite established guidelines. Overall mortality from cardiac shock has decrease but the incidence remains unchanged. Summary Emerging pharmacological interventions designed to counteract the underlying proinflammatory pathophysiologic mechanisms may in combination with early revascularization, result in improved patient outcomes, but there is no magic bullet on the horizon. Attention to the timeliness of transport and treatment of patients with a focus on revascularization is required for cardiogenic shock patients.