Cardiogenic Shock

Episode overview

Cardiogenic shock is a life-threatening state of inadequate tissue perfusion caused by severe cardiac dysfunction. The key is to recognize low-output physiology, support perfusion, and rapidly identify the underlying cause. In this episode, Chris and Mars review the classic hemodynamic pattern of cardiogenic shock, how to distinguish cardiogenic shock from septic, hypovolemic, and obstructive shock, why cool extremities, elevated jugular venous pressure, pulmonary edema, oliguria, and rising lactate matter, norepinephrine as the preferred first-line vasopressor for hypotensive cardiogenic shock, when to add an inotrope such as dobutamine or milrinone, why large fluid boluses can worsen left-sided cardiogenic shock, myocardial infarction as a major cause and the importance of emergency reperfusion, post-MI mechanical complications including papillary muscle rupture, ventricular septal rupture, and free wall rupture, and when persistent shock should prompt invasive hemodynamic assessment and consideration of temporary mechanical circulatory support. Episode pearl: Support the pressure with norepinephrine, support cardiac output with an inotrope when needed, and always treat the cause of the shock.