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

Attending to the catastrophic outcome of cardiogenic shock in a very short time span, its diagnosis must be reached as early as possible, in order for proper therapy to be started. Therefore and due to the unstable state of these patients, the diagnostic evaluations are usually performed as supportive measures are initiated. The diagnostic measures should start with the proper history and physical examination, including blood pressure beasurements, followed by an EKG, chest x-ray and collection of blood samples for evaluation.

Diagnostic Evaluation

• In clinical trials, particularly the SHOCK trial, cardiogenic shock in patients with acute myocardial infarction has been defined as:

• 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 (on support)
• Pulmonary capillary wedge pressure of at least 15 mm Hg

Diagnostic Criteria

• Clinical Criteria

• Sustained hypotension (SBP <90 mm Hg or MAP 30 mm Hg below baseline in preexisting hypertension for at least 30 minutes)
• Evidence of tissue hypoperfusion (such as oliguria, cyanosis, cool extremities, and altered mental status)
• Presence of myocardial dysfunction after exclusion or correction of non-myocardial factors contributing to tissue hypoperfusion (such as hypovolemia, hypoxia, and acidosis)

• Hemodynamic Criteria

• Sustained hypotension (SBP <90 mm Hg or MAP 30 mm Hg below baseline in preexisting hypertension for at least 30 minutes)
• Depressed cardiac index (<1.8 L/min/m² of BSA without support or <2.0–2.2 L/min/m² of BSA with support) in the presence of an elevated wedge pressure (>15 mm Hg).

References

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