How to approach and treat cardiogenic shock? Update and perspectives on pharmacological and mechanical treatment

Rodrigo Gopar-Nieto, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Mariana García-Villarejo, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Romeo Arias-Escarpulli, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Daniel Manzur-Sandoval, Terapia Postquirúrgica, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Jorge A. Ortega-Hernández, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Hector González-Pacheco, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Daniel Sierra-Lara Martinez, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Diego Araiza-Garaygordobil, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Alexandra Arias-Mendoza, Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México

Cardiogenic shock refers to the reduction in cardiac output caused by myocardial dysfunction, which results in biochemical and clinical manifestations of hypoperfusion. It is mostly due to acute coronary syndromes and less frequently to heart failure. Cardiogenic shock is the most critical state in cardiovascular patients, making timely recognition essential for initiating appropriate treatment. This involves identifying three phases of treatment: rescue, optimization, and weaning off support. The current treatment paradigm involves unloading the left ventricle and providing hemodynamic support, either through medications or ventricular or circulatory assist devices. However, none of these therapies have demonstrated short-term benefits in outcomes. Despite advancements in cardiovascular disease treatment, cardiogenic shock remains highly lethal, so understanding its pathophysiology and current therapeutic options is vital.

Keywords: Cardiogenic shock. Treatment. Ventricular support. Myocardial infarction. Heart failure.