Cardiogenic shock causes

	Cardiogenic Shock Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

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 including: myocardial or pericardial disease, valvular disease, acute coronary syndrome or different mechanical injuries to the heart, 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 outermost importance.^[1] Auxiliary tools, such as echocardiography and electrocardiography, are crucial in differentiating and identifying the possible causes of cardiogenic shock.^[2]^[3]

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

Myocardial infarction

Left ventricular failure

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	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, Tako-tsubo 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
Dental	No underlying causes
Dermatologic	No underlying causes
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, Tako-tsubo 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	No underlying causes

Causes in Alphabetical Order

Causes of Cardiogenic Shock Classified According to Underlying Pathophysiologic Mechanism

Systolic Left Ventricular Dysfunction

Acute MI

Congestive heart failure (CHF)

Cardiomyopathy

Coronary artery bypass grafting

Myocarditis

Myocardial contusion

Hypophosphatemia as can be seen in the refeeding syndrome)

Septic shock with myocardial depression

Diastolic Left Ventricular Dysfunction

Subendocardial ischemia

Excess wall stress

Valvular heart disease

Hypertensive crisis

Obstruction of Left Ventricular Outflow and Increased After Load

Aortic stenosis

Coarctation of the aorta

Hypertrophic obstructive cardiomyopathy (HOCM)

Malignant hypertension

Reversal of Flow into the Left Ventricle

Aortic insufficiency
Endocarditis
Aortic dissection
Chordal rupture, from degenerative disease or trauma^[4]

Inadequate Left Ventricular Filling due to Mechanical Causes

Inadequate Left Ventricular Filling due to Inadequate Filling Time

Tachycardia

Tachycardia mediated cardiomyopathy

Conduction Abnormalities

Atrioventricular block

Sinus bradycardia

Mechanical Defect

Ventricular septal defect (VSD)
Ruptured chordae
Myocardial rupture of the left ventricular free wall

References

↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
↑ Reynolds, H. R.; Hochman, J. S. (2008). "Cardiogenic Shock: Current Concepts and Improving Outcomes". Circulation. 117 (5): 686–697. doi:10.1161/CIRCULATIONAHA.106.613596. ISSN 0009-7322.
↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
↑ Gianni, M. (2006). "Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review". European Heart Journal. 27 (13): 1523–1529. doi:10.1093/eurheartj/ehl032. ISSN 0195-668X.

Template:WikiDoc Sources

[1] Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.

[2] Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.

[ReynoldsHochman2008-3] Reynolds, H. R.; Hochman, J. S. (2008). "Cardiogenic Shock: Current Concepts and Improving Outcomes". Circulation. 117 (5): 686–697. doi:10.1161/CIRCULATIONAHA.106.613596. ISSN 0009-7322.

[4] Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.

[Gianni2006-5] Gianni, M. (2006). "Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review". European Heart Journal. 27 (13): 1523–1529. doi:10.1093/eurheartj/ehl032. ISSN 0195-668X.

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