The medical treatment of cardiogenic shock

Abstract

Cardiogenic shock (CS) is a leading cause of mortality worldwide. CS presentation and management in the current era have been widely depicted in epidemiological studies. Its treatment is codified and relies on medical care and extracorporeal life support (ECLS) in the bridge to recovery, chronic mechanical device therapy, or transplantation. Recent improvements have changed the landscape of CS. The present analysis aims to review current medical treatments of CS in light of recent literature, including addressing excitation-contraction coupling and specific physiology on applied hemodynamics. Inotropism, vasopressor use, and immunomodulation are discussed as pre-clinical and clinical studies have focused on new therapeutic options to improve patient outcomes. Certain underlying conditions of CS, such as hypertrophic or Takotsubo cardiomyopathy, warrant specifically tailored management that will be overviewed in this review.

Keywords: Cardiogenic shock; Epidemiology; Etiology; Medical treatment; Monitoring.

Figure 1

Excitation–contraction coupling. β1-AR: β1 adrenergic receptors; AC: Adenylate cyclase; Ca²⁺: Calcium ion; LTCC: L-type Ca²⁺ channels; Na⁺: Sodium ion; NCX: Na⁺/Ca²⁺-exchanger; PDE: Phosphodiesterase; RyR: Ryanodine receptor; SERCA: SR Ca²⁺ ATPase; T-tubule: Transversal tubule.

Figure 2

Central illustration. Definition, monitoring, and medical treatment of CS. ALT: Alanine aminotransferase; AMI: Acute myocardial infarction; BPM: Beats per minute; CI: Cardiac index; CMP: Cardiomyopathy; CO: Cardiac output; CS: Cardiogenic shock; IABP: Intra-Aortic balloon pump; LV: Left ventricle; LVOT: Left ventricular outflow tract; MAP: Mean arterial pressure; PCWP: Pulmonary capillary wedge pressure; PDE-3: Phosphodiesterase 3; RAP: Right atrial pressure; SBP: Systolic blood pressure; ScvO₂: Venous blood oxygen saturation.