DIAGNOSIS OF CARDIOGENIC SHOCK: CLINICAL APPROACHES

Abstract

Cardiogenic shock (CHS) is a critical tissue hypoperfusion syndrome caused by primary cardiac dysfunction. It is the leading cause of death in patients with acute myocardial infarction (AMI), with mortality rates reaching 40-50%. This narrative review addresses the challenges and clinical strategies in diagnosing CHS. Early diagnosis is crucial, but is hampered by the heterogeneity of presentations, including phenotypes such as "normotensive cardiogenic shock." The diagnostic approach integrates clinical findings (hypotension or need for vasopressors), signs of hypoperfusion (oliguria, cold extremities), and laboratory markers (lactate >2.0 mmol/L). Invasive hemodynamic monitoring, with a pulmonary artery catheter, has gained support for accurate identification of the phenotype and to guide therapy. The five-stage SCAI classification (A-E) has emerged as a validated and essential tool for risk stratification and standardization of communication, demonstrating a strong correlation with mortality. It is concluded that a structured and rapid diagnostic approach is crucial to implementing appropriate management.