Becerra Ana Florencia, Amanamba Udochukwu, Lopez Jonathan E, Blaker Noah J, Winchester David E
Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.
College of Medicine, University of Florida, Gainesville, FL, USA.
Am Heart J Plus. 2025 Mar 10;52:100524. doi: 10.1016/j.ahjo.2025.100524. eCollection 2025 Apr.
Cardiogenic shock (CS) is a heterogeneous condition associated with exceptionally high mortality rates, despite significant advances in the field of cardiology. The primary causes of CS are myocardial infarction-related CS (AMI-CS) and acute decompensated heart failure-related CS (ADHF-CS). Management of CS is inherently complex, with the initial focus-irrespective of the underlying etiology-centered on preserving end-organ perfusion. Parenteral vasopressors and inotropes are the cornerstone of therapy to achieve this objective. However, data on the comparative efficacy of different vasoactive agents in CS remain limited, and no single agent has demonstrated clear superiority. Recent progress in the staging and phenotyping of CS has provided a framework for more tailored therapeutic approaches. This review offers a comprehensive and updated summary of current evidence on the use of vasopressors and inotropes in AMI-CS and ADHF-CS, including a discussion of specific scenarios, such as right ventricular CS (RV-CS).
心源性休克（CS）是一种异质性疾病，尽管心脏病学领域取得了重大进展，但其死亡率极高。CS的主要病因是心肌梗死相关性CS（AMI-CS）和急性失代偿性心力衰竭相关性CS（ADHF-CS）。CS的管理本质上很复杂，无论潜在病因如何，初始重点都以维持终末器官灌注为中心。胃肠外血管加压药和正性肌力药是实现这一目标的治疗基石。然而，关于不同血管活性药物在CS中的比较疗效的数据仍然有限，且没有单一药物显示出明显优势。CS分期和表型分析的最新进展为更具针对性的治疗方法提供了框架。本综述全面更新了关于血管加压药和正性肌力药在AMI-CS和ADHF-CS中应用的现有证据总结，包括对右心室CS（RV-CS）等特定情况的讨论。
