Tailoring Pharmacological Treatment in Cardiogenic Shock: A Narrative Review

Abstract

Cardiogenic shock (CS) is a critical condition marked by end-organ hypoperfusion and sustained hypotension, necessitating the use of inotropic or vasoactive agents for hemodynamic support. It is the leading cause of mortality in patients with acute myocardial infarction (AMI), exhibiting in-hospital mortality rates of 40% to 50% despite advances in treatment. Treatment strategies aim to restore hemodynamic stability and address the underlying cause through pharmacological agents and mechanical circulatory support devices. However, the persistently high mortality rates underline the challenges of a timely diagnosis, the limitations of current treatments, and the lack of a standardized multidisciplinary network of care. This review critically examines the existing literature on CS management, focusing on the efficacy, safety, and practical application of pharmacological interventions. By synthesizing evidence from recent studies, clinical guidelines, and expert consensus, our objective is to provide a useful, comprehensive, evidence-based framework to guide clinicians in the use of pharmacologic therapies tailored to the diverse presentations and stages of CS.

Keywords: Society for Cardiovascular Angiography and Intervention classification; cardiogenic shock; heart failure; hemodynamic support; inotropes; levosimendan; pharmacological treatment; vasopressors.