Key result
Cardiogenic shock in HFpEF results from impaired left ventricular filling rather than reduced contractility, requiring echocardiographic and invasive hemodynamic assessment to guide management.
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Managing cardiogenic shock in patients with preserved ejection fraction requires early recognition of the underlying etiology and guidance via echocardiography and right heart catheterization.
The classical paradigm of cardiogenic shock is severe impairment of left ventricular, right ventricular, or biventricular contractility resulting in decreased cardiac output and end-organ failure. In patients with preserved ejection fraction, cardiogenic shock results from impaired left ventricular filling leading to decreased cardiac output and end-organ hypoperfusion. Heart failure with preserved ejection fraction (HFpEF) comprises a heterogenous group of myocardial and systemic metabolic derangements. Cardiogenic shock with preserved left ventricular ejection is thought to be less common than with reduced left ventricular ejection fraction, and therapeutic approaches are not well standardized. We aim to review the pathophysiology of cardiogenic shock in HFpEF, define various etiologies that culminate in the HFpEF shock state, and present our algorithmic approach to managing these complex patients.
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Brailovsky et al. (2022) conducted an editorial in Cardiogenic shock in heart failure with preserved ejection fraction (HFpEF). Cardiogenic shock in HFpEF results from impaired left ventricular filling rather than reduced contractility, requiring echocardiographic and invasive hemodynamic assessment to guide management.
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