CARDIOGENIC SHOCK AND PULMONARY EDEMA: INTRODUCTION

Cardiogenic shock and pulmonary edema are life-threatening conditions that should be treated as medical emergencies. The most common etiology for both is severe left ventricular (LV) dysfunction, leading to pulmonary congestion and/or systemic hypoperfusion (Fig. 266-1). The pathophysiology of pulmonary edema and shock are discussed in Chaps. 33 and 264, respectively.

Figure 266-1 Pathophysiology of cardiogenic shock. Systolic and diastolic myocardial dysfunction result in a reduction in cardiac output and often pulmonary congestion. Systemic and coronary hypoperfusion occur, resulting in progressive ischemia. Although a number of compensatory mechanisms are activated in an attempt to support the circulation, these compensatory mechanisms may become maladaptive and produce a worsening of hemodynamics. *Release of inflammatory cytokines after myocardial infarction may lead to inducible nitrous oxide expression, excess NO, and inappropriate vasodilation. This causes further reduction in systemic and coronary perfusion. A vicious spiral of progressive myocardial dysfunction occurs that ultimately results in death if it is not interrupted. LVEDP, left ventricular end-diastolic pressure. (From SM Hollenberg et al: Ann Intern Med 131:47, 1999.)

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