Interventional management of cardiogenic shock

Management of the patient with cardiogenic shock requires rapid confirmation of the diagnosis and exclusion of potentially correctable conditions. Early echocardiography is helpful to exclude mechanical causes of shock, such as unsuspected severe mitral insufficiency. Thrombolytic therapy may help prevent shock, but its role in established shock is not clear. Intra-aortic balloon counterpulsation may be of value, particularly when used in conjunction with reperfusion therapy. Angiography can be performed at relatively low risk in shock patients. A window of opportunity is often available where revascularization may be of benefit.