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..................... ACS, a hypertensive emergency, rapid arrhythmias or severe bradycardia/conduction disturbance, acute mechanical causes such as acute valve regurgitation or acute pulmonary embolism, infection, including myocarditis, and tamponade (CHAMPIT) (Figure 12). After exclusion of these conditions, which need to be treated/corrected urgently, management of AHF differs according to the clinical presentations (Figures 710). Pre-discharge phase Details on this phase are shown in section 11.3.11.

11.3.2 Oxygen therapy and/or ventilatory support In AHF, oxygen should not be used routinely in non-hypoxaemic patients, as it causes vasoconstriction and a reduction in cardiac output.457 Oxygen therapy is recommended in patients with AHF and

MCS (Class IIa)

AND/OR Renal replacement

therapy (Class IIa)

OR

Consider palliative care

Management of patients with cardiogenic shock

Identify and treat other specific causesb

ACS and/or mechanical

complications

N Y

Emergency PCI or surgical treatmenta

Consider oxygen (Class I) or ventilatory

support (Class IIa) Consider inotropes/

vasopressors

(Class IIb) Consider short-term

MCS (Class IIa) AND AND

Improvement of hypoperfusion

and organ dysfunction

N Y

Weaning from inotropes/vasopressors

and/or MCS

Continue aetiological treatment if needed and medical therapy optimization

(Class I)

Figure 10 Management of cardiogenic shock. ACS = acute coronary syndrome; BTT =bridge to transplantation; MCS= mechanical circulatory support; PCI= percutaneous coronary intervention. aPCI in ACS, pericardiocentesis in tamponade, mitral valve surgery in papillary muscle rupture. In case of interventricular septum rupture, MCS as BTT should be considered. bOther causes include acute valve regurgitation, pulmonary embolism, infection, acute myocarditis, arrhythmia (see Figure 12). Downloaded from academic.oup.com/eurheartj/article/42/36/3599/6358045 by guest on 07 October 2026