20 Cardiogenic Shock	163

Cardiogenic Shock

Early shock diagnosed on

Delayed onset shock

hospital presentation

echocardiogram to rule out mechanical defects

Fibrinolytic therapy if all of the
following are present:				Arrange rapid
1- Greater than 90 minutes to PCI		IABP		transfer to invasive
2- Less than 3 hours post STEMI				capable centre
onset
3- No contraindications
Arrange prompt transfer to invasive
procedure capable centre	Cardiac catheterization and
	coronary angiography

	1–2-vessel	Moderate 3-	Severe 3-	Left main
	CAD	vessel CAD	vessel CAD	CAD
	PCI	PCI	Cannot be	Immediate
			performed	CABG
		Staged multivessel	Staged CABG
		PCI

Fig. 20.1 Cardiogenic shock

Suggested Reading

1.Topalian S, Ginsberg F, Parrillo JE. Cardiogenic shock. Crit Care Med. 2008;36(1 Suppl):S66–74.

A review article

2.Hollenberg SM. Cardiogenic shock. Crit Care Clin. 2001;17(2):391–410.

A comprehensive review article on the subject

3.Hochman JS, Sleeper LA. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK investigators. N Engl J Med. 1999;341(9):625–34.

In patients with cardiogenic shock, emergency revascularization did not significantly reduce overall mortality at 30 days. However, after 6 months, there was a significant survival benefit.