Pre-Cardiogenic Shock: A New Clinical Entity

The pathogenesis of cardiogenic shock has evolved from an acute event due to a large myocardial infarction to a semi-acute event due to rapid hemodynamic deterioration on a background of preexisting left ventricular systolic dysfunction. Pre-cardiogenic shock refers to the period of rapid hemodynamic deterioration that precedes overt cardiogenic shock with hypotension, inflammatory response and end-organ failure. Mortality remains extremely high in cardiogenic shock and has not improved over the past decades. Pre-cardiogenic shock offers a unique opportunity to initiate early treatment that may result in better clinical outcomes. The present review addresses the definition, recognition and management of pre-cardiogenic shock with pharmacologic or mechanical support of the failing left ventricle.