Therapeutic strategies for cardiogenic shock, 2006

Cardiogenic shock, a devastating consequence of acute myocardial infarction, is associated with extremely high mortality. Treatment strategies should focus on prompt reperfusion and hemodynamic support. The primary approach for therapy is emergent angiography and revascularization using percutaneous coronary intervention or coronary artery bypass surgery, with the assistance of intra-aortic balloon pump counterpulsation. Several adjunctive pharmacologic agents, particularly inotropic drugs and vasopressors, are also helpful for hemodynamic support. However, these agents have not been shown to provide a survival benefit, and their use is primarily based on clinical experience. Since our last publication, several important advances have been made in the understanding and treatment of cardiogenic shock. Recent evidence suggests that a systemic inflammatory response, including the upregulation of inducible nitric oxide synthase, complement activation, and an inflammatory cytokine cascade, play a role in the development of cardiogenic shock. Newer therapeutic strategies, including C5 inhibitors and nitric oxide synthase inhibitors, are being combined with traditional strategies, such as inotropic agents, vasopressors, and circulatory assist, to treat cardiogenic shock.