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Cardiogenic Shock Part 1: Epidemiology, Classification, Clinical Presentation, Physiological Process, and Nonmechanical Treatments

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Abstract

Shock is a state in which cardiac output is inadequate for tissue needs. In cardiogenic shock, the primary problem most often is failure of the left ventricle (LV) to adequately pump out returning blood. The majority of cases are associated with acute myocardial ischemia. Outcomes from cardiogenic shock have been improved by early aggressive therapy and, in particular, early revascularization procedures. However, as people live longer, and with many chronic conditions, non-acute acute ischemic causes of cardiogenic shock are increasing and require different therapeutic approaches. This chapter will review the epidemiology and classification of patients with cardiogenic shock. It emphasizes the physiological process involved in the failure of the LV to provide adequate flow to tissues and how best to deal with this disordered physiology. Key underlying principles are that flow to the tissues is what counts and not arterial pressure, the heart only can pump out what it gets back, and, unfortunately, there are only a limited numbers of ways to maintain organ function in cardiogenic shock. It also needs to be emphasized that earlier identification and treatment of shock can improve outcome. Cardiogenic shock continues to have a high mortality. Hopefully, a deeper understanding of the disordered process and what is physiologically achievable will help improve outcomes.

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Authors and Affiliations

  1. Royal Victoria Hospital (McGill University Health Centre), Departments of Critical Care and Physiology McGill University, Montreal, QC, Canada

    Sheldon Magder

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  1. Sheldon Magder
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  1. Royal Victoria Hospital (McGill University Health Centre), Departments of Critical Care and Physiology McGill University, Montreal, QC, Canada

    Sheldon Magder

  2. UC San Diego, Department of Medicine, La Jolla, CA, USA

    Atul Malhotra

  3. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Kathryn A. Hibbert

  4. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Charles Corey Hardin

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Magder, S. (2021). Cardiogenic Shock Part 1: Epidemiology, Classification, Clinical Presentation, Physiological Process, and Nonmechanical Treatments. In: Magder, S., Malhotra, A., Hibbert, K.A., Hardin, C.C. (eds) Cardiopulmonary Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-73387-2_50

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