Cardiogenic shock diagnostic criteria: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Cardiogenic shock}} | {{Cardiogenic shock}} | ||
{{CMG}}; {{AE}} {{AZ}} {{JS}} | {{CMG}}; {{AE}} {{AZ}}; {{JS}}; {{Rim}} | ||
==Overview== | ==Overview== | ||
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===Clinical Criteria=== | ===Clinical Criteria=== | ||
* Sustained [[hypotension]] for at least 30 minutes defined as [[systolic blood pressure]] <90 | * Sustained [[hypotension]] for at least 30 minutes defined as [[systolic blood pressure]] <90 mmHg, or [[mean arterial pressure]] 30 mmHg below baseline in preexisting [[hypertension]], or the need for supportive measures to keep the [[systolic blood pressure]] >90 mmHg | ||
* Clinical evidence of [[hypoperfusion|tissue hypoperfusion]] as manifested by [[oliguria]] (urine output <30 mL/hour), [[cyanosis]], [[cool extremities]], or [[Altered mental status|altered mental status]] | * Clinical evidence of [[hypoperfusion|tissue hypoperfusion]] as manifested by [[oliguria]] (urine output <30 mL/hour), [[cyanosis]], [[cool extremities]], or [[Altered mental status|altered mental status]] | ||
* Presence of [[myocardial]] dysfunction following exclusion or correction of possible non-[[myocardial]] factors contributing to [[hypoperfusion|tissue hypoperfusion]] such as [[hypovolemia]], [[hypoxia]], [[arrhythmia]], and [[acidosis]]<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> | * Presence of [[myocardial]] dysfunction following exclusion or correction of possible non-[[myocardial]] factors contributing to [[hypoperfusion|tissue hypoperfusion]] such as [[hypovolemia]], [[hypoxia]], [[arrhythmia]], and [[acidosis]]<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> | ||
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===Hemodynamic Criteria=== | ===Hemodynamic Criteria=== | ||
* Sustained [[hypotension]] for at least 30 minutes defined as [[systolic blood pressure]] <90 | * Sustained [[hypotension]] for at least 30 minutes defined as [[systolic blood pressure]] <90 mmHg, or [[mean arterial pressure]] 30 mmHg below baseline in preexisting [[hypertension]], or the need for supportive measures to keep the [[systolic blood pressure]] >90 mmHg | ||
* Depressed [[cardiac index]] (<1.8 L/min/m<sup>2</sup> of [[body surface area|BSA]] without support or <2.0–2.2 L/min/m<sup>2</sup> of [[body surface area|BSA]] with support) | * Depressed [[cardiac index]] (<1.8 L/min/m<sup>2</sup> of [[body surface area|BSA]] without support or <2.0–2.2 L/min/m<sup>2</sup> of [[body surface area|BSA]] with support) | ||
* Elevated [[PCWP|pulmonary capillary wedge pressure]] (>15 mm Hg) | * Elevated [[PCWP|pulmonary capillary wedge pressure]] (>15 mm Hg) | ||
Revision as of 14:12, 20 January 2015
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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]; João André Alves Silva, M.D. [3]; Rim Halaby, M.D. [4]
Overview
Cardiogenic shock is the presence of tissue hypoperfusion secondary to decreased cardiac output in the context of adequate intravascular volume.
Diagnostic Criteria
Clinical Criteria
- Sustained hypotension for at least 30 minutes defined as systolic blood pressure <90 mmHg, or mean arterial pressure 30 mmHg below baseline in preexisting hypertension, or the need for supportive measures to keep the systolic blood pressure >90 mmHg
- Clinical evidence of tissue hypoperfusion as manifested by oliguria (urine output <30 mL/hour), cyanosis, cool extremities, or altered mental status
- Presence of myocardial dysfunction following exclusion or correction of possible non-myocardial factors contributing to tissue hypoperfusion such as hypovolemia, hypoxia, arrhythmia, and acidosis[1][2][3]
Hemodynamic Criteria
- Sustained hypotension for at least 30 minutes defined as systolic blood pressure <90 mmHg, or mean arterial pressure 30 mmHg below baseline in preexisting hypertension, or the need for supportive measures to keep the systolic blood pressure >90 mmHg
- Depressed cardiac index (<1.8 L/min/m2 of BSA without support or <2.0–2.2 L/min/m2 of BSA with support)
- Elevated pulmonary capillary wedge pressure (>15 mm Hg)
- Adequate filling pressure (left ventricular end-diastolic pressure >18 mm Hg or right ventricular end-diastolic pressure >10–15 mm Hg)
- Elevated arteriovenous oxygen difference (>5.5 mL/dL)[1][3][4][5][6]
References
- ↑ 1.0 1.1 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) - ↑ Hollenberg, SM.; Kavinsky, CJ.; Parrillo, JE. (1999). "Cardiogenic shock". Ann Intern Med. 131 (1): 47–59. PMID 10391815. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 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) - ↑ 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) - ↑ 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) - ↑ 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)