Cardiogenic shock diagnostic criteria
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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]
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 ad systolic blood pressure <90 mm Hg, or systolic blood pressure 30 mm Hg 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 ad systolic blood pressure <90 mm Hg, or systolic blood pressure 30 mm Hg 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)