Identifying cardiogenic shock in the emergency department |
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| Affiliation: | 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota;2. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota;3. Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota;4. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota;5. Department of Medicine, Amita Health Saint Joseph Hospital, Chicago, Illinois;6. Division of Cardiovascular Medicine, Department of Medicine, Louisiana State University School of Medicine, Shreveport, Louisiana;7. Department of Medicine, Mayo Clinic, Rochester, Minnesota;8. Division of Nephrology, Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi;9. Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota;1. Duke University Medical Center, Duke Clinical Research Institute, Durham Veterans Administration, Durham, NC;2. Duke University Medical Center, Cardiovascular Devices Unit, eECG Core Laboratories, Duke Clinical Research Institute, Durham, NC;3. Center for Research on Healthcare Data Center (CRHC-DC), Center for Clinical Trials & Data Coordination (CCDC), Division of General Internal Medicine, University of Pittsburgh School of Medicine, Circulation: Cardiovascular Interventions, Pittsburgh, PA;4. Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH;5. Abbott, Austin, TX;6. Office of Product Evaluation and Quality, CDRH | Food and Drug Administration, 10903 New Hampshire Ave., Silver Spring, MD;7. Abiomed, Danvers, MA;8. Mount Sinai Medical Center, New York, NY;9. Pennsylvania State University, Heart and Vascular Institute, Hershey, PA;10. The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, The Carl and Edyth Lindner Family Distinguished Chair in Clinical Research, The Christ Hospital Health Network, Cincinnati, OH;11. NYU-HHC Clinical and Translational Science Institute, New York University School of Medicine, NYU Langone Health, New York, NY;12. The CardioVascular Center, Tufts Medical Center Boston, MA;13. U.S. Food and Drug Administration, CDRH/OPEQ/Office of Clinical Evidence and Analysis (OCEA), 10903 New Hampshire Ave, Silver Spring, MD;14. University of Ottawa Heart Institute, Medical Adviser Health Canada, Ottawa, Ontario;15. Thomas Jefferson University, Philadelphia, PA;p. Cardiovascular Division, Department of Medicine, Brigham and Women''s Hospital, Harvard Medical School, Boston, MA;q. Duke Clinical Research Institute, Durham, NC;r. Duke Program for Advanced Coronary Disease, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC;s. Wayne State University, Detroit, MI;t. Department of Perioperative Medicine, St. Bartholomew''s Hospital, London;u. Duke University Health System, Durham, NC;v. Division of Cardiovascular and Renal Products, Center for Drug Evaluation and Research, US Food and Drug Administration, Washington, DC;w. U.S. Food and Drug Administration, Center for Drug Evaluation and Research, 10903 New Hampshire Ave, Silver Spring, MD;x. Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology Leipzig, Germany, Leipzig Heart Institute, Leipzig, Germany;y. Virginia Heart, INOVA Heart and Vascular Institute, Alexandria, VA;z. Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC;11. Duke University Health System Section Chief, Cardiology, Durham VA Health System, Durham, NC |
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| Abstract: | IntroductionCardiogenic shock is difficult to diagnose due to diverse presentations, overlap with other shock states (i.e. sepsis), poorly understood pathophysiology, complex and multifactorial causes, and varied hemodynamic parameters. Despite advances in interventions, mortality in patients with cardiogenic shock remains high. Emergency clinicians must be ready to recognize and start appropriate therapy for cardiogenic shock early.ObjectiveThis review will discuss the clinical evaluation and diagnosis of cardiogenic shock in the emergency department with a focus on the emergency clinician.DiscussionThe most common cause of cardiogenic shock is a myocardial infarction, though many causes exist. It is classically diagnosed by invasive hemodynamic measures, but the diagnosis can be made in the emergency department by clinical evaluation, diagnostic studies, and ultrasound. Early recognition and stabilization improve morbidity and mortality. This review will focus on identification of cardiogenic shock through clinical examination, laboratory studies, and point-of-care ultrasound.ConclusionsThe emergency clinician should use the clinical examination, laboratory studies, electrocardiogram, and point-of-care ultrasound to aid in the identification of cardiogenic shock. Cardiogenic shock has the potential for significant morbidity and mortality if not recognized early. |
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