Cardiogenic Shock Complicating Myocardial Infarction

Cardiogenic shock is the primary cause of death among patients hospitalized with acute myocardial infarction. It is defined as tissue hypoperfusion resulting from ventricular pump failure in the presence of adequate intravascular volume. These patients need rapid assessment and appropriate institution of supportive therapies including vasopressor and inotropic agents, ventilatory support, and intra-aortic balloon pump counterpulsation. Emergency coronary artery revascularization is the only therapy that reduces mortality, and this should be provided early to patients to achieve maximal benefit, unless further care is deemed futile. Whereas newer support devices can provide better hemodynamic augmentation, their impact on mortality is limited. Novel therapies are needed to further decrease mortality rates, which remain high despite reperfusion therapy.