Pump failure

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Cardiogenic shock can be split into two main categories: shock due to pump failure or shock due to mechanical complications of infarction (for example, acute valve failure, tamponade, or acute ventricular septal defects) which will not be discussed further. Over the last 20 years there have been major advances in the treatment of myocardial infarction and in outcome. Despite this the incidence and outcome from cardiogenic shock has remained roughly the same. It is a major cause of death among patients with acute coronary syndromes. The incidence of cardiogenic shock is around 7-10%. The majority occurs after ST elevation myocardial infarction, but 3% occurs in patients with unstable angina and 2% in patients with non-ST elevation MI. Hospital mortality is 45-80%.

Randomised trials have tended to define cardiogenic shock as a systolic blood pressure of < 90 mmHg for at least 1 hour that is not responsive to fluid administration alone, that is secondary to cardiac dysfunction, or that is associated with signs of hypoperfusion (or cardiac index <2 2 litre per minute m-2 and pulmonary capillary wedge pressure more than 18 mmHg). In essence, the mainstay of diagnosis is a sustained systolic blood pressure of < 90 mmHg with evidence of organ hypoperfusion.

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