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Cardiogenic shock

Key sources
The following summarized guidelines for the evaluation and management of cardiogenic shock are prepared by our editorial team based on guidelines from the Heart Failure Society of America (HFSA/AHA/ACC 2022), the European Society of Cardiology (ESC 2021), and the American Heart Association (AHA/ACC 2013).
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Guidelines

1.Diagnostic procedures

Pulmonary artery catheterization: consider placing a pulmonary artery line to define hemodynamic subsets and appropriate management strategies in patients presenting with cardiogenic shock.
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  • Coronary angiography

2.Medical management

General principles: consider managing patients with cardiogenic shock by a multidisciplinary team experienced in shock.
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  • Inotropes

  • Vasopressors

  • Fibrinolytic therapy

3.Therapeutic procedures

Mechanical circulatory support
As per ACC 2022 guidelines:
Consider triaging patients not rapidly responding to initial shock measures to centers providing temporary mechanical circulatory support to optimize management.
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Consider initiating temporary mechanical circulatory support in patients with cardiogenic shock when end-organ function cannot be maintained by pharmacologic means to support cardiac function.
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  • Mechanical circulatory support (ACCF)

  • Intra-aortic balloon pump

  • Intra-aortic balloon pump (ACCF)

  • Coronary revascularization