REVIEW article
Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1653306
Cardiometabolic Shock: Understanding the Final Turns of the Downward Spiral
Provisionally accepted
- 1UC Irvine Medical Center, Irvine, United States
- 2UC Davis Medical Center, Sacramento, United States
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Cardiogenic shock (CS) is a state of decreased cardiac output leading to systemic hemodynamic collapse and potential end-organ damage with an elevated risk of mortality. CS represents a heterogenous disease state with varying etiologies, severities, and hemodynamics. Several attempts have been made to characterize CS, including the Society of Cardiovascular Angiography & Interventions shock classification (SCAI), the American Heart Association (AHA) hemodynamic phenotypes, as well as other groups defining shock by underlying clinical factors and pathophysiology. Here, we review cardiometabolic shock, a complex and severe form of CS characterized by severe lactic acidosis and metabolic derangement, systemic inflammation with ischemia/reperfusion injury, persistent vasodilation despite hemodynamic support, and right heart failure, culminating in progressive end-organ failure and a downward spiral of cardiovascular instability. Understanding the components of pathophysiology underlying cardiometabolic shock may help to establish more accurate diagnosis and instituting prompt therapy in the management of this grave cardiac illness. The emerging roles of nitric oxide synthase inhibition, antioxidants, anti-inflammatory agents, proteomics, and artificial intelligence are discussed. Further studies are needed to fully understand cardiometabolic shock and to develop specific effective therapeutic targets.
Keywords: cardiometabolic shock, Cardiogenic shock, Inflammation, Lactic acidosis, Mechanical circulatory support
Received: 24 Jun 2025; Accepted: 16 Sep 2025.
Copyright: © 2025 Mathew, Kim and Gibson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Tobin Mathew, mathewtj@hs.uci.edu
Michael A. Gibson, magibson66@gmail.com
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