This handout is for cardiogenic shock — after non-cardiac surgery (perioperative). Your care team identified this based on: post-op troponin elevated within 30d of non-cardiac surgery → screen for mins (8–19% incidence per vision pmid 24686072).
Other reasons your team may use this plan: pod 0–7: sbp <90 + lactate ≥2 + hypoperfusion → perioperative cs workup; post-op dyspnea + chest pain + tachycardia → screen for perioperative mi vs pe vs occult cs; new lv dysfunction on post-op echo (drop ≥10 ef points from pre-op baseline).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| aspirin | 81 mg PO daily — CONTINUE if pre-op or INITIATE if MINS / new ACS pattern | PO | daily | POISE-2 (PMID 24679062) — neither benefit nor harm pre-op; weigh individually. POST-op MINS or ischemia → continue/initiate per 2024 ACC/AHA Perioperative (PMID 39236235) |
| atorvastatin | 40–80 mg PO daily — CONTINUE pre-op statin and INITIATE if newly diagnosed MINS/ACS | PO | daily | Strong evidence for pre-op statin continuation; initiation per 2024 ACC/AHA Perioperative (PMID 39236235); secondary prevention post-MINS |
| norepinephrine | 0.05–0.5 µg/kg/min IV titrate to MAP ≥65 | IV | continuous | SOAP-II first-line (PMID 20200382); maintains coronary perfusion without precipitating tachy-arrhythmia |
| dobutamine | 2.5–5 µg/kg/min IV (low-dose) | IV | continuous | Inotropic support if CI <2.2; balance arrhythmia risk in post-op state (DOREMI PMID 33704937) |
| carvedilol | CONTINUE pre-op BB at home dose; do NOT initiate de novo per POISE PMID 18479744; if needed post-recovery, start carvedilol 3.125 mg BID titrate | PO | BID | POISE (PMID 18479744) — perioperative metoprolol initiation INCREASED stroke + death; CONTINUE pre-op BB; INITIATE only after recovery + indication (HFrEF, ACS, AF rate control) |
| dabigatran | 110 mg PO BID (per MANAGE PMID 30340966 dosing) — CONSIDER for MINS without overt ACS | PO | BID | MANAGE 2018 (PMID 30340966) — dabigatran reduced major vascular events in MINS by 28%; weigh post-op bleed risk; avoid if CrCl <30 |
| apixaban | 5 mg PO BID (or 2.5 mg BID per renal/age criteria) | PO | BID | AC for new-onset AF or post-op PE; weigh against bleed risk; ACC/AHA 2023 AF guideline |
| furosemide | 20–40 mg IV (lower than HF doses to avoid over-diuresis) | IV | q12h prn | Decongest post-op fluid shifts AFTER MAP stable; cautious in AKI |
Plan: Perioperative CS after non-cardiac surgery — driver-directed therapy (transfuse anemia, control pain, continue/initiate ASA + statin, BB selectively NOT de novo, dabigatran consideration for MINS)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
MINS triggers post-op cardiology follow-up at 30d (high 30-d mortality 9.8% per VISION); secondary prevention initiation (ASA, statin, BB, ACEi as appropriate); cardiac rehab; re-evaluate AC strategy per MANAGE; pre-op risk stratification for future surgeries
Guideline: 2024 ACC/AHA Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery (Thompson Circulation 2024, PMID 39236235) + ESC 2022 Non-cardiac Surgery Cardiovascular Guideline + SCAI 2022 CS staging (Naidu PMID 35718438) + 2022 AHA/ACC/HFSA HF Guideline (PMID 35363499)