End-organ hypoperfusion from primary cardiac dysfunction: SBP <90 for >30 min or vasopressors to maintain, with hypoperfusion signs.
Causes
- • Large MI (>40% LV loss)
- • Mechanical complications (VSR, MR, tamponade)
- • Fulminant myocarditis
- • Decompensated HF
- • Massive PE, arrhythmia
Clinical features
- • Cool clammy skin, oliguria, altered mental state
- • Hypotension
Investigations
- • Bedside echo, ECG, troponin, lactate, ABG
- • PA catheter (CI <2.2, PCWP >15)
- • Coronary angiography if ACS
Management
- • Immediate revascularisation (culprit-only PCI, CULPRIT-SHOCK)
- • Vasopressor (norad) + inotrope (dobutamine or milrinone)
- • IABP not routinely (IABP-SHOCK II)
- • Consider Impella, VA-ECMO
- • Correct mechanical complications surgically
Complications
- • Multiorgan failure
- • Bowel ischaemia
- • Bleeding on MCS
Clinical pearls
- • Mortality 40-50%
- • Early transfer to CS centre with MCS
References
- • ESC 2021 HF Guidelines
- • SCAI Shock Classification 2019
Related in WardRound
Educational — verify locally.
