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Zum Bild des klassischen KS geh\u00f6ren ein systolischer Blutruck &lt;\u200990\u202fmmHg, eine Lungenstauung, Nierenversagen, isch\u00e4mische Hepatitis (Schockleber) sowie die klinischen Zeichen der Zentralisierung (Zyanose, k\u00fchle Extremit\u00e4ten). Allgemein akzeptierte h\u00e4modynamische Cutoffs sind ein Herzzeitindex &lt;\u20092,2\u202f(l\/min)\/m<jats:sup>2<\/jats:sup>sowie ein pulmonalkapill\u00e4rer Verschlussdruck &gt;\u200915\u202fmmHg. Es gibt auch eine sogenannte nichthypotensive Velaufsform des KS mit erhaltehem Blutdruck.<\/jats:p><jats:p>Die bei weitem h\u00e4ufigste Ursache des KS ist nach wie vor das durch ausgedehnten Myokardinfarkt ausgel\u00f6ste Pumpversagen und die Mortalit\u00e4tsrate konnte dank breiter Verf\u00fcgbarkeit der prim\u00e4ren PCI auf ca. 40\u201350% gesenkt werden. Bei der akuten PCI im infarktbedingten KS soll nach derzeitigem Kenntnisstand nur das schuldige Koronargef\u00e4\u00df wiederer\u00f6ffnet werden.<\/jats:p><jats:p>Weitere wichtige Ursachen sind mechanische Infrarktkomplikationen wie Papillarmuskelruptur, Ventrikelseptumruptur oder Ruptur der freien Wand (i.\u202fe. die Perikardtamponade), Myokarditis und Kardiomyopathien im fortgeschrittenen stadium, sowie Klappenerkrankungen, vor allem die hochgradige Aortenklappenstenose.<\/jats:p><jats:p>In der Diagnostik des KS spielen Anamnese, klinische Untersuchung, EKG und vor allem die Echokardiographie und die Herzkatheteruntersuchung eine entscheidende Rolle. Die Echokardiographie sollte immer vor der Herzkatheterdiagnostik durchgef\u00fchrt werden, da sie bei Vorliegen mechanischer Komplikatonen das weitere Vorgehen (operativ vs interventionell) entscheidend beeinflusst. Bei Zeichen des KS in Gegenwart einer paradoxerweise guten Linksventrikelfunktion muss unbedingt an eine Papillarmuskelruptur gedacht werden, insbesondere wenn ein Lateralinfarkt vorliegt.<\/jats:p><jats:p>Die medikament\u00f6se Stabilisierung sollte prim\u00e4r mit Noradrenalin und Dobutamin erfolgen, beim Versagen konventioneller Therapiema\u00dfnahmen kann heute auf mechanische Unterst\u00fctzungsverfahren wie z.b ECMO oder Impella\u00a9 zur\u00fcckgegriffen werden. Die Frage inwieweit, bzw. welchen Patienten diese Verfahren einen Vorteil bieten k\u00f6nnen, ist derzeit Gegenstand laufender klinischer Studien.<\/jats:p>","DOI":"10.1007\/s00508-020-01612-1","type":"journal-article","created":{"date-parts":[[2020,2,24]],"date-time":"2020-02-24T17:08:26Z","timestamp":1582564106000},"page":"333-348","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Kardiogener Schock","Cardiogenic shock"],"prefix":"10.1007","volume":"132","author":[{"given":"Robert","family":"Zilberszac","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gottfried","family":"Heinz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,2,24]]},"reference":[{"issue":"8","key":"1612_CR1","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1002\/clc.22564","volume":"39","author":"HS Lim","year":"2016","unstructured":"Lim\u00a0HS. 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