[Cardiogenic shock - State of the art pathophysiology, therapy and prognosis].

Abstract

Cardiogenic shock is not a singular disease but rather a complex syndrome - characterized by systemic hypoperfusion, elevated intracardiac pressures, and insufficient cardiac output due to various possible underlying causes, leading to an acute, life-threatening, and critical condition.Significant advancements have been made in recent years in understanding the epidemiology, clinical course, phenotyping, hemodynamics, and the standardized classification of disease severity. However, progress in therapeutic interventions aimed at improving prognosis has been comparatively limited, with only a few therapies demonstrating significant evidence in randomized controlled trials. Among these, early revascularization in infarct-related cardiogenic shock (Acute Myocardial Infarction with Cardiogenic Shock - AMICS) has remained a key therapy for more than 20 years, and more recently, the use of percutaneous left ventricular assist devices in selected patients.Many questions remain unanswered, including the optimal pharmacotherapeutic regimen, the role of other mechanical support systems, the management of secondary organ dysfunction, and the best approach to supportive care.