Causes of cardiogenic shock

Acute myocardial infarction

Pump failure

Large infarction, generally involving ≥40 percent of the left ventricle

Smaller infarction with preexisting left ventricular dysfunction or a prior infarction

Infarction extension or expansion

Reinfarction

Mechanical complications

Acute mitral regurgitation caused by rupture of a papillary muscle or chordae tendinae or severe papillary muscle dysfunction

Ventricular septal defect caused by rupture of the interventricular septum

Left ventricular free wall rupture

Pericardial tamponade due to rupture of the left ventricular free wall or hemorrhagic pericardial effusion

Right ventricular infarction

Other conditions

End-stage cardiomyopathy

Myocarditis

Septic shock with severe myocardial depression

Left ventricular outflow tract obstruction

Aortic stenosis

Hypertrophic obstructive cardiomyopathy

Obstruction to left ventricular filling

Mitral stenosis

Left atrial myxoma

Toxicity causing severe myocardial depression (eg, beta blocker, calcium channel blocker, or clonidine overdose)

Dysrhythmia

Acute mitral regurgitation (chordal rupture)

Acute aortic insufficiency (eg, aortic dissection)

Myocardial contusion

Prolonged cardiopulmonary bypass

Adapted from Hollenberg SM, Kavinsky CJ, Parrillo JE. Ann Intern Med 1999; 131:47.

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