42  Cardiogenic Shock

• cool extremities

• narrow pulse pressure (See Chapter 3)

• labored breathing

• Cheyne-Stokes respiration

• abdominal bloating/nausea

• End-organ dysfunction: oliguria, AMS, etc.

• Phenotypes

  • ACS-related cardiogenic shock
  • acute-on-chronic heart failure related cardiogenic shock

42.1 Etiologies of CS

General Cause	Specific Etiologies
Ischemic	Acute myocardial infarction Unstable angina with global ischemia Right ventricular infarction Complications of ischemic heart disease Papillary muscle rupture Acute ventricular septal defect Myocardial rupture
Valvular	Severe aortic stenosis or insufficiency Severe mitral regurgitation or stenosis Severe pulmonic stenosis or regurgitation Severe tricuspid regurgitation or stenosis
Myocardial disease/unknown	Acute myocarditis Giant cell myocarditis Takotsubo stress myocarditis Substance abuse Toxins Chemotherapeutic agents End-stage ischemic or nonischemic cardiomyopathy
Extracardiac	Cardiac tamponade Acute aortic dissection with aortic insufficiency, tamponade, or rupture Large pulmonary embolism
End-stage congenital heart disease