Cardiogenic Shock: The First Six Hours — Book by Dr Thirugnanam

Why I wrote this book

Cardiogenic shock is where interventional cardiology, intensive care and emergency medicine collide, and where delay is measured in organs. I have watched excellent teams lose time not through lack of knowledge but through lack of sequence: the echo done late, the lactate not trended, the support device chosen after the window had closed.

The evidence has been sobering too. The SHOCK trial established early revascularisation; IABP-SHOCK II, CULPRIT-SHOCK and ECLS-SHOCK showed that more is not automatically better; DanGer Shock reopened the question of microaxial support in selected patients. This book is my attempt to turn that evidence into a timeline a team can follow.

Built around the clock

• Recognise and define — early clinical signs, ECG and echocardiography, laboratory and perfusion markers, shock classification and haemodynamic phenotype.
• Restore perfusion — culprit-vessel revascularisation in infarct-related shock, vasopressor and inotrope selection, fluids and ventilation.
• Choose support — IABP, Impella, TandemHeart and VA-ECMO: selection, timing, cannulation, monitoring and left-ventricular unloading.
• Specific causes — mechanical complications of infarction, right-ventricular and biventricular failure, myocarditis and post-cardiotomy shock.
• Protect the patient — preventing multiorgan failure and recognising bleeding, vascular, thrombotic and neurological complications; escalation and de-escalation.

Algorithms, checklists and decision pathways sit throughout so the book can be used on the unit, not only read beforehand.

Who I had in mind

Interventional and general cardiologists, intensivists, emergency physicians and anaesthesiologists, and the fellows, residents, nurses and perfusionists who make up a shock team.

The book at a glance

Questions readers ask me

Is this only for cath-lab teams?

No. The early recognition, phenotyping and vasoactive chapters are written as much for emergency and ICU teams, who usually see the patient first.

Does it help with device choice?

Yes. Selection, timing, escalation and weaning of each support platform are discussed, including VA-ECMO physiology and unloading.

Are non-infarct causes covered?

Yes — mechanical complications, right-ventricular failure, myocarditis and post-cardiotomy shock each have dedicated discussion.