[Treatment of cardiogenic shock with exclusion of inotropic drugs]

Cardiogenic shock comprises peripheral hypoperfusion and pulmonary vascular overload. The goals of therapy are to reduce pulmonary congestion by lowering pulmonary capillary wedge pressure and to increase cardiac index. Volume loading is the first step of treatment. It helps to place the patient on the Franck-Starling relationship. This challenge studies the effects of an increased preload on stroke volume. It has to be done even in case of major heart failure. The main effect of venous vasodilators is to decrease myocardial oxygen consumption. Arteriolar vasodilators also decrease left ventricular end systolic volume. Fluid overload may be treated by diuretics or by extra renal devices: peritoneal dialysis or hemofiltration. Intractable cardiogenic shock may respond to cardiac assist devices (intra aortic balloon pump, pump assistance) as a bridge to surgery.