Controversies inControversies inTreatingTreatingCardiogenicCardiogenicShockShock

Martha Burk, MD, MSMartha Burk, MD, MS

BAMC/Wilford Hall/UTHSCSABAMC/Wilford Hall/UTHSCSACombined Pulmonary FellowsCombined Pulmonary FellowsConferenceConference

Cardiogenic ShockCardiogenic Shock

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Inadequate perfusion of tissue withInadequate perfusion of tissue withrelatively decreased cardiacrelatively decreased cardiacdysfunctiondysfunction

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It is the most common cause of It is the most common cause of death in patients hospitalized fordeath in patients hospitalized forAMIAMI

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Treatment of AMI complicated by Treatment of AMI complicated bycardioenic shock remains

Two Minute Two MinuteAssessmenAssessmentt

Cold and DryCold and DryNoWarm andWarm andDryDry YesWarm and WetWarm and WetCold and WetCold and Wet

Evidence of LowPerfusion

Narrow pulse pressureNarrow pulse pressurePulsus paradoxusPulsus paradoxusCool extremitiesCool extremitiesAltered mental statusAltered mental statusDrug-related hypotensionDrug-related hypotensionHyponatremiaHyponatremiaWorsening renal functionWorsening renal function

Evidence forCongestion

OrthopneaOrthopneaElevated JVPElevated JVPGallopGallopEdemaEdemaAscitesAscitesRalesRalesHepatojugular refluxHepatojugular reflux

Congestion at rest?LowPerfusionAt Rest?No Yes

Nohria, et al JAMA 2002