Cardiogenic shock: can the prognosis be improved?

The prognosis in cardiogenic shock remains poor despite improvements in treating other complications of acute myocardial infarction. In some situations, left ventricular function can be improved by increasing the vascular volume, but the benefits of increasing the cardiac uutput must be balanced agains the risk of pulmonary edema. Monitoring of volume therapy is best done via the pulmonary route. The goal of drug therapy is to raise arterial blood pressure and make the heart pump more effectively. An aggressive approach will not cure great numbers of extensive myocardial damage remains, but it will identify those who are hypovolemic or who have other correctable contributory factors. Most important, this approach may help to identify therapies currently in use that may actually increase rather than lessen myocardial damage.