Cardiogenic shock

Cardiogenic shock is a clinical syndrome caused by severe cardiac pump dysfunction, with severely reduced cardiac output, inability to supply the metabolic needs of organs and tissues, resulting in peripheral circulatory failure and severe microcirculatory disturbance. Clinically, cardiogenic shock is mainly caused by acute myocardial infarction complicated by severe pump failure. High-risk factors for myocardial infarction complicated by cardiogenic shock include advanced age, anterior wall myocardial infarction, hypertension, diabetes, multivessel disease, ST-segment elevation myocardial infarction, history of myocardial infarction or angina, history of heart failure, and left bundle branch block. Clinical manifestations of patients with cardiogenic shock mainly include severe underlying heart disease manifestations. Systemic circulatory failure manifestations: persistent hypotension, oliguria, disturbance of consciousness, peripheral cyanosis, etc.; may also be combined with acute pulmonary edema manifestations; arterial pressure <10.7 kPa (80 mmHg); central venous pressure normal or elevated; extremely low cardiac output. Drug therapy, intra-aortic balloon counterpulsation, reperfusion, and left ventricular assist devices are currently the main treatment methods for cardiogenic shock. Drug therapy mainly includes positive inotropic drugs and vasoconstrictors. Intra-aortic balloon counterpulsation (IABP) is an important treatment measure for cardiogenic shock. After placement of IABP, the balloon deflates during cardiac systole, so that peripheral vascular resistance does not increase; during cardiac diastole, the balloon inflates, increasing coronary perfusion pressure and coronary perfusion. Since the vast majority of cardiogenic shock is caused by ST-segment elevation acute myocardial infarction, reperfusion therapy [emergency PCI, coronary artery bypass grafting (CABG), thrombolytic therapy] for these patients to restore coronary blood perfusion is of extremely important value for improving and restoring cardiac function. Left ventricular assist devices temporarily and partially replace cardiac function with the aid of external mechanical devices, helping tissue perfusion, awaiting recovery of cardiac function, and interrupting the vicious cycle of cardiogenic shock. They are an important treatment measure for cardiogenic shock. Patients with cardiogenic shock are critically ill with a high mortality rate. However, once treatment is effective, the long-term prognosis of these patients is relatively good.