BoardsBridgeCardiogenic Shock After Myocardial Infarction
Pathophysiology, SCAI staging, hemodynamic optimization, and mechanical circulatory support in post-MI pump failure
Post-MI cardiogenic shock is acute LV pump failure from loss of contractile myocardium causing hypotension, low output, and end-organ hypoperfusion — treat with emergent culprit-vessel PCI, MAP ≥65 with norepinephrine first, add inotropy, and escalate to mechanical circulatory support by SCAI stage.
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HEADLINE: Cold & wet LV pump failure — revascularize, maintain MAP with norepinephrine first, add inotrope, escalate to MCS by SCAI stage.
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Key numbers
- MAP goal ≥65 mmHg with adequate coronary perfusion pressure
- Norepinephrine 0.05–0.5 mcg/kg/min IV — first-line vasopressor
- Dobutamine 2–20 mcg/kg/min IV — inodilator, pair with vasopressor
- Milrinone 0.375–0.75 mcg/kg/min IV — avoid if SBP <80 mmHg
- Emergent culprit PCI target: <2 hours from shock onset
- SCAI C hemodynamics: CI <2.2 L/min/m², SBP <90 mmHg, lactate >2
- Cardiac power output <0.6 W = high mortality threshold
- Impella support up to 5.5 L/min (CP, 5.0, 5.5); watch for hemolysis
- Furosemide 20–80 mg IV for pulmonary edema with adequate BP
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: AHA Cardiogenic Shock 2023 · Scai Cardiogenic Shock 2023 · Iscvi Impella Management 2022
Re-review cadence: 12 months from reviewed date.
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Card ID: cardiogenic-post-mi · Path: aba.critical-care.shock-states.cardiogenic-post-mi