# Cardiogenic shock


Categorizing shock:
![alt](https://photos.collectednotes.com/photos/5187/2ba49f2a-c6e1-4f30-9853-1737a0560615)

- Preschock normotensive Hypoperfusion
- Preshock hypotensive normoperfusion
- LV-dominant 
- RV-dominant
- Bi-V CS

Based on invasive hemodynamic parameters. Note: ESCAPE trial - decompensated HF - RCT with no benefit to RHC/Swan, however not in shock patients. Some subsequent retrospective data that does suggest a benefit. 

Cardiac Power Output: MAP & CO / 451. The strongest correlate of mortality; 0.53W is the threshold, can be used to track response.

Pulmonary Artery Pulsatility Index: [PAS - PAD] / [CVP or RAP]. If PA Capacitance and CPWP is constant, it's a proxy for the Frank-Starling relationship. Studied mostly who will need RV support when getting LVAD

Shock Stages: 

- E: extremis
- D: deteriorating/Doom - c, but not responding
- C: Classic cardiogenic shock - hypotension
- B: beginning cardiogenic shock - relative hypotension or compensatory tachycardia without hypo perfusion.
- A: pre-shock/ at risk


Shock team approach? Maybe earlier/more MCS in pre-post

![alt](https://photos.collectednotes.com/photos/5187/c241b54b-59a9-451e-9bd2-aaf2827cfa7e)