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Cardiogenic Shock — RACP Adult Medicine MCQ

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EasyCardiologyCardiogenic ShockRACP Adult Medicine

A 60-year-old man with anterior STEMI presents with BP 80/50 mmHg, HR 110 bpm, raised JVP, bilateral pulmonary crackles, cold peripheries, and a new pansystolic murmur. Echo shows LVEF 20% and severe mitral regurgitation. Lactate is 5.8 mmol/L. What is the most likely type of shock?

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Correct answer: E — Cardiogenic shock

Hypotension with raised JVP, pulmonary oedema, cold peripheries, and severely reduced LVEF post-STEMI with acute MR is cardiogenic shock. Cardiogenic shock complicates ~5-8% of STEMI. Management includes urgent revascularisation (PCI), inotropes (dobutamine or milrinone), vasopressors (noradrenaline), and consideration of mechanical circulatory support (IABP, Impella).

Reference: CSANZ – 2025 – ACS Guidelines; ESC 2021 HF