Cardiogenic Shock – Left Ventricular Dysfunction
Cardiogenic shock, as a consequence of left ventricular dysfunction, is an ominous complication of STEMI and indicates significant myocardial damage.
How does it usually occur?
It usually occurs as a consequence of anterior AMI, or in the presence of Left bundle branch block (LBBB).
It is characterised by systemic hypoperfusion (tachycardia, reduced systolic blood pressure, cool peripheries and reduced renal output), associated with adequate central venous filling pressures. Clinical assessment should aim to exclude other causes of hypotension (hypovolaemia, arrythmias, drug related side effects, right ventricular infarction and mechanical complications of STEMI).
What is the most effective treatment?
The most effective treatment for cardiogenic shock is early and effective myocardial reperfusion: for these patients PPCI, if available, is superior to thrombolysis [6]. In addition to reperfusion, specific measures to treat hypotension may be required (eg. the use of inotropes and/or an intra-aortic balloon pump), particularly where there is evidence of poor cerebral or renal perfusion.