Cardiometabolic shock: understanding the final turns of the downward spiral

Area of Science:

• Cardiology
• Critical Care Medicine
• Pathophysiology

Background:

• Cardiogenic shock (CS) is a critical condition characterized by reduced cardiac output, leading to hemodynamic collapse and end-organ damage.
• CS is a heterogeneous state with diverse causes, severities, and hemodynamic profiles.
• Existing classifications like SCAI and AHA phenotypes attempt to characterize CS.

Purpose of the Study:

• To review cardiometabolic shock (CMS), a severe CS subtype.
• To elucidate the complex pathophysiology of CMS, including metabolic derangement, inflammation, and right heart failure.
• To discuss emerging therapeutic strategies and the need for further research.

Main Methods:

• Literature review of cardiometabolic shock.
• Analysis of existing CS classifications and hemodynamic phenotypes.
• Discussion of pathophysiological components and potential therapeutic targets.

Main Results:

• Cardiometabolic shock is defined by severe lactic acidosis, metabolic derangement, systemic inflammation, ischemia/reperfusion injury, vasodilation, and right heart failure.
• These factors contribute to progressive end-organ failure and cardiovascular instability.
• Understanding CMS pathophysiology is crucial for diagnosis and prompt therapy.

Conclusions:

• Cardiometabolic shock represents a grave form of CS with a complex interplay of metabolic, inflammatory, and hemodynamic factors.
• Emerging research areas include nitric oxide synthase inhibition, antioxidants, anti-inflammatory agents, proteomics, and AI.
• Further investigation is essential to fully comprehend CMS and develop targeted, effective treatments.