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Reviews in Cardiovascular Medicine  2021, Vol. 22 Issue (3): 691-715     DOI: 10.31083/j.rcm2203078
Special Issue: Contemporary Management of Special Subsets of Acute Coronary Syndromes Patients
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Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome
Rasha Kaddoura1, *(), Salah Elbdri2
1Pharmacy Department, Heart Hospital, Hamad Medical Corporation, 3050 Doha, Qatar
2Cardiology Department, Heart Hospital, Hamad Medical Corporation, 3050 Doha, Qatar
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Abstract:
Cardiogenic shock (CS) is a hemodynamically complex and highly morbid syndrome characterized by circulatory collapse and inadequate end-organ perfusion due to impaired cardiac output. It is usually associated with multiorgan failure and death. Mortality rate is still high despite advancement in treatment. CS has been conceptualised as a vicious cycle of injury and decompensation, both cardiac and systemic. Interrupting the vicious cycle and restoring the hemodynamic stability is a fundamental treatment of CS. Acute coronary syndrome (ACS) is the most frequent cause of CS. Early coronary revascularization is a cornerstone therapy that reduces mortality in patients with ACS complicated by CS. Early diagnosis of CS accompanied with invasive hemodynamics, helps in identification of CS phenotype, classification of CS severity, stratification of risk and prognostication. This can guide a tailored and optimized therapeutic approach. Inotropes and vasopressors are considered the first-line pharmacological option for hemodynamic instability. The current availability of the mechanical circulatory support devices has broadened the therapeutic choices for hemodynamic support. To date there is no pharmacological or nonpharmacological intervention for CS that showed a mortality benefit. The clinical practices in CS management remain inconsistent. Herein, this review discusses the current evidence in the diagnosis and management of CS complicating ACS, and features the changes in CS definition and classification.
Key words:  Acute myocardial infarction      Cardiogenic shock      Inotrope      Mechanical circulatory support      Pulmonary artery catheter      Vasopressor     
Submitted:  10 June 2021      Revised:  14 July 2021      Accepted:  03 August 2021      Published:  24 September 2021     
*Corresponding Author(s):  rkaddoura@hamad.qa; Rasha.kaddoura@gmail.com (Rasha Kaddoura)   

Cite this article: 

Rasha Kaddoura, Salah Elbdri. Current evidence in the diagnosis and management of cardiogenic shock complicating acute coronary syndrome. Reviews in Cardiovascular Medicine, 2021, 22(3): 691-715.

URL: 

https://rcm.imrpress.com/EN/10.31083/j.rcm2203078     OR     https://rcm.imrpress.com/EN/Y2021/V22/I3/691

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