[Pharmacotherapy of cardiogenic shock]

The definition and classification of the various forms of circulatory shock are outlined, together with the causes and management of cardiogenic shock. The pharmacotherapeutic possibilities in patients with shock following myocardial infarction are discussed: over the last 15 years several alpha and beta adrenergic stimulants, as well as alpha-blocking agents, have been included in the treatment of this severe circulatory failure; today the most commonly used drugs in cardiogenic shock are dopamine and dobutamine, sometimes in combination with vasodilators. Dopamine appears to be indicated when low cardiac output, arterial hypotension and oliguria are present; dobutamine, a positive inotropic acting drug, should be used when arterial hypotension is only moderate but combined with elevated filling pressures. Despite the various therapeutic approaches the mortality of cardiogenic shock, which reaches 10-15% of patients with acute myocardial infarction, is still high (70-90%); an improvement may be expected with newer forms of therapy (fibrinolysis, dilatation). Finally, a concept for the management of cardiogenic shock following myocardial infarction is presented.