ACC — 2025 Concise Clinical Guidance: Evaluation and Management of Cardiogenic Shock
American College of Cardiology, 2025
Use rapid etiologic diagnosis, serial shock-severity assessment and hemodynamic phenotyping; norepinephrine is generally preferred when vasopressor support is required; use invasive hemodynamics selectively to guide phenotype and temporary mechanical circulatory support decisions, with early shock-team/advanced-center involvement for refractory shock.
Clinical Context & Relevant Topics (4)
Disease ReferencePrimary pump failure, SCAI staging (A–E), PAC hemodynamics (CPO, PAPi), inotrope selection, emergent revascularization, and mechanical circulatory support.
Plaque rupture, coronary thrombosis, STEMI vs NSTEMI risk stratification, emergent reperfusion, DAPT/anticoagulation, and mechanical/electrical ICU complications.
Hemodynamic phenotypes (SCAPE vs ADHF vs Cardiogenic Shock), non-invasive positive pressure ventilation, high-dose vasodilator algorithms, loop diuretics, and sequential nephron blockade.
RV anatomy and ischemia spiral, ventricular interdependence (D-sign), echocardiographic metrics (TAPSE, S', PAPi, VExUS), and the 4-pillar resuscitation strategy.