Cardiogenic Shock

Kristen A. Smith1, Michael T. Bigham2, *
1 Department of Pediatrics
2 Division of Critical Care Medicine, Akron Children’s Hospital Department of Critical Care, USA

© 2013 Smith and Bigham

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Akron Children's Hospital, Division of Critical Care Medicine, One Perkins Square, Akron, OH 44308- 1062, USA; Tel: (330) 543-8639; Fax: (330) 543-8136; E-mail:


The primary function of the cardiovascular system is to provide oxygen and energy substrates to the body's tissues. In all forms of shock, there is metabolic failure - a downstream consequence of an inability to meet the metabolic demands of the tissue. In cardiogenic shock, the primary derangement leading to unmet tissue metabolic demands is cardiac dysfunction. Though cardiac impairment may be implicated in other categories of shock, primary cardiac failure in the form of cardiogenic shock is the third most common type of shock in pediatrics – trailing septic shock and hypovolemic shock. Myocardial malfunction, in other forms of shock, is secondary to ischemia, acidosis, drugs, toxins, or direct myocardial depressants due to inflammation. Cardiogenic shock, a low-output state, is characterized by elevated ventricular filling pressures, low cardiac output, systemic hypotension, and evidence of end-organ hypoperfusion. Herein, we will highlight the pathophysiology of cardiogenic shock, the various causative etiologies, the multitude of laboratory or imaging diagnostic options, current advances in therapies, and outcomes in patients.

Keywords: Pediatric cardiogenic shock, cardiac transplant, congenital heart disease, congestive cardiac failure, extracorporeal membrane oxygenation, myocarditis, ventricular assist device.