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| ==Overview== | | ==Overview== |
| Cardiogenic shock may occur in the setting of different [[cardiac]] conditions, therefore assessing its source in the [[cardiac]] [[patient]] may be challenging. These [[cardiac]] conditions may involve different structures of the [[heart]] and originate different pathologies, including: [[myocardial]] or [[pericardial]] disease, [[valvular disease]], [[acute coronary syndrome]] or other mechanical injuries that may be causative or simply contributive to the shock, described below. Nevertheless, considering the predominance of [[coronary artery disease]] today, [[ACS]] is the most common cause of this type of [[shock]]. To reach the right [[diagnosis]], the clinician will have to gather information from the history and clinical examination, however, since most conditions may present with overlapping [[syndromes]], timing and changes in these findings are of uttermost importance.<ref>{{Cite book | last1 = Hasdai | first1 = David. | title = Cardiogenic shock : diagnosis and treatmen | date = 2002 | publisher = Humana Press | location = Totowa, N.J. | isbn = 1-58829-025-5 | pages = }}</ref> Auxiliary tools, such as [[echocardiography]] and [[electrocardiography]], are crucial in differentiating and identifying the possible causes of cardiogenic shock.<ref>{{Cite book | last1 = Hasdai | first1 = David. | title = Cardiogenic shock : diagnosis and treatmen | date = 2002 | publisher = Humana Press | location = Totowa, N.J. | isbn = 1-58829-025-5 | pages = }}</ref><ref name="ReynoldsHochman2008">{{cite journal|last1=Reynolds|first1=H. R.|last2=Hochman|first2=J. S.|title=Cardiogenic Shock: Current Concepts and Improving Outcomes|journal=Circulation|volume=117|issue=5|year=2008|pages=686–697|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.613596}}</ref>
| | The most common cause of cardiogenic shock is [[acute myocardial infarction]] with [[left ventricular]] dysfunction. Less commonly, [[right ventricular]] [[myocardial infarction]] can lead to cardiogenic shock. Other causes of cardiogenic shock include mechanical injuries such as acute valvular regurgitation or rupture, free wall rupture, and [[ventricular septum]] rupture. |
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| ==Causes== | | ==Causes== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
The most common cause of cardiogenic shock is acute myocardial infarction with left ventricular dysfunction. Less commonly, right ventricular myocardial infarction can lead to cardiogenic shock. Other causes of cardiogenic shock include mechanical injuries such as acute valvular regurgitation or rupture, free wall rupture, and ventricular septum rupture.
Causes
Life Threatening Causes
Cardiogenic Shock is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions may result in death or permanent disability within 24 hours if left untreated.
Common Causes
The most common causes of cardiogenic shock remain:[1]
However, other likewise important causes must be identified. These may be classified according to their nature into:
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Causes by Organ System
| Cardiovascular
|
Acute aortic perforation, Acute aortic syndrome, Acute coronary syndrome, Acute myocardial infarction, Acute pulmonary embolism, Acute stent thrombosis, Acute valvular regurgitation, Anterior myocardial dysfuntion, Aortic dissection, Aortic insufficiency, Aortic regurgitation, Aortic stenosis, Apical ballooning cardiomyopathy, Arrhythmias, Atrial fibrillation, Atrial flutter, Atrial myxoma, Atrioventricular block, Bezold-Jarisch reflex, Cardiac tamponade, Chordal rupture, Coarctation of the aorta, Compression of the heart, Congenital lesions, Congestive heart failure, Constrictive pericarditis, Coronary artery bypass grafting, Coronary artery disease, Dilated cardiomyopathy, Endocarditis, Excess ventricular wall stress, Free wall rupture, Hemorrhagic pericardial effusion, Hypertensive crisis, Hypertrophic cardiomyopathy, Hypophosphatemia, Hypoxic pulmonary vasoconstriction, Inferior myocardial infarction, Inferoposterior infarction, Interventricular septum rupture, Left ventricle failure, Left ventricular free wall rupture, Mechanical obstruction, Mitral regurgitation, Mitral stenosis, Multivessel coronary artery disease, Myocardial disease, Myocardial infarction, Myocarditis, Myopericarditis, Non-ST elevation myocardial infarction (NSTEMI), Papillary muscle dysfunction, Papillary muscle rupture, Pericardial disease, Pericardial effusion, Pericardial tamponade, Pneumothorax, Prior valvular disease, Pulmonary embolism, Retrograde dissection of ascending aorta, Right ventricle infarction, Right ventricular failure, Rupture of chordae tendineae, Ruptured ventricular free wall aneurysm, Septic shock with myocardial depression, Severe cardiomyopathy, Severe pulmonary hypertension, Sinus bradycardia, ST elevation myocardial infarction (STEMI), Stress-induced cardiomyopathy, Subendocardial ischemia, Takotsubo cardiomyopathy, Tension pneumothorax, Three vessel coronary disease, Unsuspected coronary dissection, Unsuspected coronary perforation, Valvular defect, Valvular disease, Vasodilators, Venodilators, Ventricular fibrillation, Ventricular septal defect, Ventricular septal rupture, Ventricular tachycardia
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| Chemical/Poisoning
|
No underlying causes
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| Dental
|
No underlying causes
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| Dermatologic
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No underlying causes
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| Drug Side Effect
|
Anaphylaxis, Angiotensin converting enzyme inhibitors, Beta-blockers, Calcium channel blockers, Diuretics, Morphine, Nitrates, Vasodilators, Venodilators
|
| Ear Nose Throat
|
No underlying causes
|
| Endocrine
|
No underlying causes
|
| Environmental
|
No underlying causes
|
| Gastroenterologic
|
No underlying causes
|
| Genetic
|
Congenital lesions, Valvular defect, Ventricular septal defect
|
| Hematologic
|
Hypophosphatemia
|
| Iatrogenic
|
Acute aortic perforation, Acute stent thrombosis, Anaphylaxis, Angiotensin converting enzyme inhibitors, Beta-blockers, Calcium channel blockers, Coronary artery bypass grafting, Diuretics, Iatrogenic, Morphine, Nitrates, Unsuspected coronary dissection, Unsuspected coronary perforation, Vasodilators, Venodilators
|
| Infectious Disease
|
No underlying causes
|
| Musculoskeletal/Orthopedic
|
No underlying causes
|
| Neurologic
|
Apical ballooning cardiomyopathy, Bezold-Jarisch reflex, Sinus bradycardia, Stress-induced cardiomyopathy, Takotsubo cardiomyopathy
|
| Nutritional/Metabolic
|
No underlying causes
|
| Obstetric/Gynecologic
|
No underlying causes
|
| Oncologic
|
Atrial myxoma
|
| Ophthalmologic
|
No underlying causes
|
| Overdose/Toxicity
|
No underlying causes
|
| Psychiatric
|
No underlying causes
|
| Pulmonary
|
Acute pulmonary embolism, Hypoxic pulmonary vasoconstriction, Pneumothorax, Pulmonary embolism, Severe pulmonary hypertension, Tension pneumothorax
|
| Renal/Electrolyte
|
No underlying causes
|
| Rheumatology/Immunology/Allergy
|
Anaphylaxis, Constrictive pericarditis, Endocarditis, Myocarditis, Myopericarditis, Septic shock with myocardial depression
|
| Sexual
|
No underlying causes
|
| Trauma
|
Acute aortic perforation, Aortic dissection, Chordal rupture, Compression of the heart, Papillary muscle rupture, Pericardial tamponade, Retrograde dissection of ascending aorta, Rupture of chordae tendineae, Trauma, Ventricular septal rupture
|
| Urologic
|
No underlying causes
|
| Miscellaneous
|
Acute aortic syndrome, Acute coronary syndrome, Acute myocardial infarction, Acute pulmonary embolism, Acute valvular regurgitation, Anterior myocardial dysfuntion, Aortic dissection, Aortic insufficiency, Aortic regurgitation, Aortic stenosis, Apical ballooning cardiomyopathy, Arrhythmias, Atrial fibrillation, Cardiac tamponade, Chordal rupture, Coarctation of the aorta, Compression of the heart, Congestive heart failure, Coronary artery disease, Dilated cardiomyopathy, Endocarditis, Excess ventricular wall stress, Free wall rupture, Hemorrhagic pericardial effusion, Hypertensive crisis, Hypertrophic cardiomyopathy, Hypophosphatemia, Hypoxic pulmonary vasoconstriction, Inferior myocardial infarction, Inferoposterior infarction, Interventricular septum rupture, Left ventricle failure, Left ventricular free wall rupture, Mechanical obstruction, Mitral regurgitation, Mitral stenosis, Multivessel coronary artery disease, Myocardial disease, Myocardial infarction, Myocarditis, Myopericarditis, Non-ST elevation myocardial infarction (NSTEMI), Papillary muscle dysfunction, Papillary muscle rupture, Pericardial disease, Pericardial effusion, Pericardial tamponade, Pneumothorax, Prior valvular disease, Pulmonary embolism, Retrograde dissection of ascending aorta, Right ventricle infarction, Right ventricular failure, Rupture of chordae tendineae, Ruptured ventricular free wall aneurysm, Septic shock with myocardial depression, Severe cardiomyopathy, Severe pulmonary hypertension, Sinus bradycardia, ST elevation myocardial infarction (STEMI), Stress-induced cardiomyopathy, Subendocardial ischemia, Takotsubo cardiomyopathy, Tension pneumothorax, Three vessel coronary disease, Valvular defect, Valvular disease, Ventricular fibrillation, Ventricular septal defect, Ventricular septal rupture, Ventricular tachycardia
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Causes in Alphabetical Order
Causes of Cardiogenic Shock Classified According to Underlying Pathophysiologic Mechanism
Systolic Left Ventricular Dysfunction
Diastolic Left Ventricular Dysfunction
Obstruction of Left Ventricular Outflow and Increased After Load
Reversal of Flow into the Left Ventricle
Inadequate Left Ventricular Filling due to Mechanical Causes
Inadequate Left Ventricular Filling due to Inadequate Filling Time
Conduction Abnormalities
Mechanical Defect
Right Ventricular Failure
Iatrogenic
Miscellaneous
References
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