Post myocardial infarction cardiogenic shock: a review of current therapies

J Intensive Care Med. 2013 May-Jun;28(3):151-65. doi: 10.1177/0885066611411407. Epub 2011 Jul 11.

Abstract

Cardiogenic shock is often a devastating consequence of acute myocardial infarction (MI) and portends to significant mortality and morbidity. Despite improvements in expediting the time to treatment and enhancements in available medical therapy and reperfusion techniques, cardiogenic shock remains the most common cause of mortality following MI. Post-MI cardiogenic shock most commonly occurs as a consequence of severe left ventricular dysfunction. Right ventricular (RV) MI must also be considered. Mechanical complications including acute mitral regurgitation, ventricular septal rupture, and ventricular free-wall rupture can also lead to cardiogenic shock. Rapid diagnosis of cardiogenic shock and its underlying cause is pivotal to delivering definitive therapy. Intravenous vasoactive agents and mechanical support devices may temporize the patient's hemodynamic status until definitive therapy by percutaneous or surgical intervention can be performed. Despite prompt management, post-MI cardiogenic shock mortality remains high.

Keywords: cardiogenic shock; mechanical complications; myocardial infarction.

Publication types

  • Review

MeSH terms

  • Cardiac Tamponade / diagnosis
  • Cardiac Tamponade / etiology
  • Cardiac Tamponade / therapy
  • Critical Care / methods*
  • Heart Rupture, Post-Infarction / diagnosis
  • Heart Rupture, Post-Infarction / etiology
  • Heart Rupture, Post-Infarction / therapy
  • Heart-Assist Devices
  • Humans
  • Mitral Valve Insufficiency / diagnosis
  • Mitral Valve Insufficiency / etiology
  • Mitral Valve Insufficiency / therapy
  • Myocardial Infarction / complications
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / etiology
  • Myocardial Infarction / therapy
  • Prognosis
  • Risk Factors
  • Shock, Cardiogenic / diagnosis
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / physiopathology
  • Shock, Cardiogenic / therapy*
  • Time-to-Treatment
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / etiology*
  • Ventricular Dysfunction, Left / therapy