CARDIOGENIC-SHOCK

Cardiogenic shock (CS), defined as forward failure combined with systo lic blood pressure <90 mm Hg and reduced organ perfusion despite adequ ate volume loading, still has a grim prognosis with mortality rates of 80-100% if the causes are left untreated. The most frequent condition s underlying CS are acute myocardial infarction, acute and severe aort ic or mitral incompetence, rapidly progressive dilatative cardiomyopat hy and hypertrophic obstructive cardiomyopathy. Whereas correct conser vative management by drugs and pacing may be life saving in the latter , the other conditions require early invasive management. Indications for cardiac surgery and circulatory assistance are given for mechanica l complications leading to CS. In CS complicating myocardial infarctio n, comprehensive management with early invasive revascularization and intraaortic balloon pumping may result in improved survival compared w ith the disappointing outcome of medical treatment, including fibrinol ysis. This strategy can be offered to the majority of infarct patients in CS, who are primarily admitted to hospitals not equipped for inter ventional cardiology or cardiac surgery. Between-hospital transfer of these patients for PTCA (or surgery) and advanced intensive care has b een shown to be feasible and safe.