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==Diagnostic Evaluation==
==Diagnostic Evaluation==


In clinical trials, cardiogenic shock has been defined as follows by the SHOCK investigators:<ref>Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999; 341 (9) : 625–34.</ref>
* In clinical trials, cardiogenic shock in patients with acute myocardial infarction has been defined as follows by the SHOCK investigators:<ref name="Hochman-1999">{{Cite journal  | last1 = Hochman | first1 = JS. | last2 = Sleeper | first2 = LA. | last3 = Webb | first3 = JG. | last4 = Sanborn | first4 = TA. | last5 = White | first5 = HD. | last6 = Talley | first6 = JD. | last7 = Buller | first7 = CE. | last8 = Jacobs | first8 = AK. | last9 = Slater | first9 = JN. | title = Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. | journal = N Engl J Med | volume = 341 | issue = 9 | pages = 625-34 | month = Aug | year = 1999 | doi = 10.1056/NEJM199908263410901 | PMID = 10460813 }}</ref>


'''1- Persistent [[hypotension]]:'''<br>
:* Presence of ST-segment elevation, Q-wave infarction, new left bundle-branch block, or posterior infarction with anterior ST-segment depression, complicated by shock due predominantly to left ventricular dysfunction.
* [[Systolic blood pressure]] <80 to 90 mm Hg, '''or'''<br>
:* Hypotension (a systolic blood pressure of <90 mm Hg for at least 30 minutes or the need for supportive measures to maintain a systolic blood pressure of ≥90 mm Hg)
* [[Mean arterial pressure]] 30 mm Hg lower than baseline<br>
:* End-organ hypoperfusion (cool extremities or a urine output of <30 ml per hour, and a heart rate of ≥60 beats per minute)
:* Cardiac index of no more than 2.2 liters per minute per square meter of body-surface area
:* Pulmonary-capillary wedge pressure of at least 15 mm Hg


'''AND'''<br>
==Diagnostic Criteria==


'''2- Severe decrease in the [[cardiac index]] (CI):'''<br>
* ''Clinical Criteria''<ref name="Califf-1994">{{Cite journal  | last1 = Califf | first1 = RM. | last2 = Bengtson | first2 = JR. | title = Cardiogenic shock. | journal = N Engl J Med | volume = 330 | issue = 24 | pages = 1724-30 | month = Jun | year = 1994 | doi = 10.1056/NEJM199406163302406 | PMID = 8190135 }}</ref><ref name="Hollenberg-1999">{{Cite journal  | last1 = Hollenberg | first1 = SM. | last2 = Kavinsky | first2 = CJ. | last3 = Parrillo | first3 = JE. | title = Cardiogenic shock. | journal = Ann Intern Med | volume = 131 | issue = 1 | pages = 47-59 | month = Jul | year = 1999 | doi =  | PMID = 10391815 }}</ref><ref name="Goldberg-1991">{{Cite journal  | last1 = Goldberg | first1 = RJ. | last2 = Gore | first2 = JM. | last3 = Alpert | first3 = JS. | last4 = Osganian | first4 = V. | last5 = de Groot | first5 = J. | last6 = Bade | first6 = J. | last7 = Chen | first7 = Z. | last8 = Frid | first8 = D. | last9 = Dalen | first9 = JE. | title = Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988. | journal = N Engl J Med | volume = 325 | issue = 16 | pages = 1117-22 | month = Oct | year = 1991 | doi = 10.1056/NEJM199110173251601 | PMID = 1891019 }}</ref>
* CI <1.8 L/min/m<sup>2</sup> without support, '''or'''<br>
* CI <2.0 to 2.2 L/min/m<sup>2</sup> with support<br>


'''AND'''<br>
:* Sustained [[hypotension]] ([[systolic blood pressure|SBP]] &lt;90 mm Hg or [[mean arterial pressure|MAP]] 30 mm Hg below baseline in preexisting [[hypertension]] for at least 30 minutes)
:* Evidence of [[hypoperfusion|tissue hypoperfusion]] (such as [[oliguria]], [[cyanosis]], [[cool extremities]], and [[Altered mental status|altered mental status]])
:* Presence of [[myocardial]] dysfunction after exclusion or correction of non-[[myocardial]] factors contributing to [[hypoperfusion|tissue hypoperfusion]] (such as [[hypovolemia]], [[hypoxia]], and [[acidosis]])


'''3- Adequate or elevated filling pressure:'''<br>
* ''Hemodynamic Criteria''<ref name="Califf-1994">{{Cite journal  | last1 = Califf | first1 = RM. | last2 = Bengtson | first2 = JR. | title = Cardiogenic shock. | journal = N Engl J Med | volume = 330 | issue = 24 | pages = 1724-30 | month = Jun | year = 1994 | doi = 10.1056/NEJM199406163302406 | PMID = 8190135 }}</ref><ref name="Goldberg-1991">{{Cite journal  | last1 = Goldberg | first1 = RJ. | last2 = Gore | first2 = JM. | last3 = Alpert | first3 = JS. | last4 = Osganian | first4 = V. | last5 = de Groot | first5 = J. | last6 = Bade | first6 = J. | last7 = Chen | first7 = Z. | last8 = Frid | first8 = D. | last9 = Dalen | first9 = JE. | title = Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988. | journal = N Engl J Med | volume = 325 | issue = 16 | pages = 1117-22 | month = Oct | year = 1991 | doi = 10.1056/NEJM199110173251601 | PMID = 1891019 }}</ref><ref name="Forrester-1976">{{Cite journal  | last1 = Forrester | first1 = JS. | last2 = Diamond | first2 = G. | last3 = Chatterjee | first3 = K. | last4 = Swan | first4 = HJ. | title = Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts). | journal = N Engl J Med | volume = 295 | issue = 24 | pages = 1356-62 | month = Dec | year = 1976 | doi = 10.1056/NEJM197612092952406 | PMID = 790191 }}</ref><ref name="Forrester-1976-2">{{Cite journal  | last1 = Forrester | first1 = JS. | last2 = Diamond | first2 = G. | last3 = Chatterjee | first3 = K. | last4 = Swan | first4 = HJ. | title = Medical therapy of acute myocardial infarction by application of hemodynamic subsets (second of two parts). | journal = N Engl J Med | volume = 295 | issue = 25 | pages = 1404-13 | month = Dec | year = 1976 | doi = 10.1056/NEJM197612162952505 | PMID = 790194 }}</ref><ref name="Reynolds-2008">{{Cite journal  | last1 = Reynolds | first1 = HR. | last2 = Hochman | first2 = JS. | title = Cardiogenic shock: current concepts and improving outcomes. | journal = Circulation | volume = 117 | issue = 5 | pages = 686-97 | month = Feb | year = 2008 | doi = 10.1161/CIRCULATIONAHA.106.613596 | PMID = 18250279 }}</ref>
* Left ventricular end-diastolic pressure >18 mm Hg, '''or'''<br>
 
* Right ventricular end-diastolic pressure >10 to 15 mm Hg
:* Sustained [[hypotension]] ([[systolic blood pressure|SBP]]  &lt;90 mm Hg or [[mean arterial pressure|MAP]] 30 mm Hg below baseline in preexisting [[hypertension]] for at least 30 minutes)
:* Depressed [[cardiac index]] (&lt;1.8 L/min/m<sup>2</sup> of [[body surface area|BSA]] without support or &lt;2.0–2.2 L/min/m<sup>2</sup> of [[body surface area|BSA]] with support) in the presence of an elevated [[PCWP|wedge pressure]] (&gt;15 mm Hg).
<!--
:* Adequate filling pressure (left ventricular end-diastolic pressure &gt;18 mm Hg or right ventricular end-diastolic pressure &gt;10–15 mm Hg)
:* Elevated [[arteriovenous oxygen difference]] (&gt;5.5 mL/dL)
-->


==References==
==References==

Revision as of 15:44, 24 April 2014

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]

Diagnostic Evaluation

  • In clinical trials, cardiogenic shock in patients with acute myocardial infarction has been defined as follows by the SHOCK investigators:[1]
  • Presence of ST-segment elevation, Q-wave infarction, new left bundle-branch block, or posterior infarction with anterior ST-segment depression, complicated by shock due predominantly to left ventricular dysfunction.
  • Hypotension (a systolic blood pressure of <90 mm Hg for at least 30 minutes or the need for supportive measures to maintain a systolic blood pressure of ≥90 mm Hg)
  • End-organ hypoperfusion (cool extremities or a urine output of <30 ml per hour, and a heart rate of ≥60 beats per minute)
  • Cardiac index of no more than 2.2 liters per minute per square meter of body-surface area
  • Pulmonary-capillary wedge pressure of at least 15 mm Hg

Diagnostic Criteria

References

  1. ↑ Hochman, JS.; Sleeper, LA.; Webb, JG.; Sanborn, TA.; White, HD.; Talley, JD.; Buller, CE.; Jacobs, AK.; Slater, JN. (1999). "Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock". N Engl J Med. 341 (9): 625–34. doi:10.1056/NEJM199908263410901. PMID 10460813. Unknown parameter |month= ignored (help)
  2. ↑ 2.0 2.1 Califf, RM.; Bengtson, JR. (1994). "Cardiogenic shock". N Engl J Med. 330 (24): 1724–30. doi:10.1056/NEJM199406163302406. PMID 8190135. Unknown parameter |month= ignored (help)
  3. ↑ Hollenberg, SM.; Kavinsky, CJ.; Parrillo, JE. (1999). "Cardiogenic shock". Ann Intern Med. 131 (1): 47–59. PMID 10391815. Unknown parameter |month= ignored (help)
  4. ↑ 4.0 4.1 Goldberg, RJ.; Gore, JM.; Alpert, JS.; Osganian, V.; de Groot, J.; Bade, J.; Chen, Z.; Frid, D.; Dalen, JE. (1991). "Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988". N Engl J Med. 325 (16): 1117–22. doi:10.1056/NEJM199110173251601. PMID 1891019. Unknown parameter |month= ignored (help)
  5. ↑ Forrester, JS.; Diamond, G.; Chatterjee, K.; Swan, HJ. (1976). "Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts)". N Engl J Med. 295 (24): 1356–62. doi:10.1056/NEJM197612092952406. PMID 790191. Unknown parameter |month= ignored (help)
  6. ↑ Forrester, JS.; Diamond, G.; Chatterjee, K.; Swan, HJ. (1976). "Medical therapy of acute myocardial infarction by application of hemodynamic subsets (second of two parts)". N Engl J Med. 295 (25): 1404–13. doi:10.1056/NEJM197612162952505. PMID 790194. Unknown parameter |month= ignored (help)
  7. ↑ Reynolds, HR.; Hochman, JS. (2008). "Cardiogenic shock: current concepts and improving outcomes". Circulation. 117 (5): 686–97. doi:10.1161/CIRCULATIONAHA.106.613596. PMID 18250279. Unknown parameter |month= ignored (help)


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