Thelansis

  Cardiogenic shock (CS) is a complex and highly morbid entity conceptualized as a vicious cycle of injury, cardiac and systemic decompensation, and further damage and decompensation. The primary insult is a reduction in myocardial contractility resulting in diminished cardiac output, hypotension, systemic vasoconstriction, and cardiac ischemia. The hallmark is peripheral vasoconstriction and vital end-organ damage, resulting from ineffective stroke volume and insufficient circulatory compensation. Compensatory peripheral vasoconstriction may initially improve coronary and peripheral perfusion. However, it contributes to increased cardiac afterload that overburdens damaged myocardium. This results in diminished oxygenated blood flow to peripheral tissue and the heart. Systemic inflammation causes pathological vasodilation, releasing nitric oxide synthase and peroxynitrite, which have cardiotoxic inotropic effects. Interleukins and tumor necrosis factor-alpha (TNF-a) are additional ...