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Cardiogenic shock: evolving definitions and future directions in management
  1. Tara L Jones1,
  2. Kenta Nakamura2 and
  3. James M McCabe2
  1. 1Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
  2. 2Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr James M McCabe; jmmccabe{at}


Cardiogenic shock (CS) is a complex and highly morbid entity conceptualised as a vicious cycle of injury, cardiac and systemic decompensation, and further injury and decompensation. The pathophysiology of CS is incompletely understood but limited clinical trial experience suggests that early and robust support of the failing heart to allow for restoration of systemic homoeostasis appears critical for survival. We review the pathophysiology, clinical features and trial data to construct a contemporary model of CS as a systemic process characterised with maladaptive compensatory mechanisms requiring prompt and appropriately tailored medical and mechanical support for optimal outcomes. We conclude with an algorithmic approach to acute CS incorporating clinical and haemodynamic data to match the patient’s cardiac and systemic needs as a template for contemporary management.

  • cardiogenic shock
  • myocardial infarction
  • heart failure
  • mechanical circulatory support
  • temporary circulatory support

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  • TLJ and KN contributed equally.

  • Contributors TLJ, KN and JMM conceived the presented concepts. TLJ and KN performed the literature review and drafted the manuscript and figures. KN and JMM revised the final manuscript. KN and JMM are responsible for the overall content as guarantor.

  • Funding Publication fees were supported by the Bruce-Laughlin Fellow Award at the University of Washington, Division of Cardiology.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.