Cardiogenic Shock

Cardiogenic shock typically is triggered by a heart attack, and is definitely life-threatening. Even with treatment, it ends in death 65 to 80 percent of the time. Cardiogenic shock is characterized by a decreased pumping ability of the heart that causes a shocklike state with inadequate perfusion to the tissues.

Cardiogenic shock results from the inability of the heart to pump blood through the body. Cardiogenic Shock is the most serious consequence of myocardial infarction, but can also result from other cardiac emergencies, such as cardiac tamponade. A sudden and severe drop in the blood pressure and blood flow through the body because the heart is not pumping normally.Cardiogenic shock caused by cardiac arrest. Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively The usual cause is myocardial infarction. However, there are some noncoronary causes such as cardiomyopathy, valvular heart abnormalities, cardiac tampanade, or cardiac arrhythmias. These patients would generally have poor cardiac output. Clinically they will have tissue hypoxia resulting in oliguria, cyanosis, altered mentation, and cool extremities. The patient may require intraaortic balloon pump therapy, ventricular assistive device, or might ultimately require cardiac transplant. Systolic BP < 90 mm Hg, or 30 mm Hg below baseline for at least 30 mins, evidence of poor tissue perfusion and persistence of shock after correction of non-myocardial factors (eg hypovolaemia, hypoxia, acidosis, arrhythmias)

Acute hypoperfusion of the tissues and organs, usually with associated hypotension, due to a primary failure of the pump action of the heart, where the circulating blood volume is adequate. Cardiogenic shock occurs when the heart is unable to pump blood and maintain an adequate blood supply for other vital organs. Cardiogenic shock has a death rate of about 60% and is the major cause of death in patients hospitalized for a heart attack. Getting immediate medical treatment for a heart attack is important in preventing the development of cardiogenic shock. Commonest cause is myocardial death/stunning after infarction or critical ischaemia.

Cause of Cardiogenic Shock

Some causes of Cardiogenic Shock follows:

• Valvular/structural - Mitral stenosis, endocarditis, mitral or aortic regurgitation, atrial myxoma or thrombus, and tamponade
• Losing about 1/5 or more of the normal amount of blood in your body causes hypovolemic shock.
• Blood loss can be due to bleeding from cuts or other injury or internal bleeding such as gastrointestinal tract bleeding. The amount of blood in your body may drop when you lose too many other body fluids, which can happen with diarrhea, vomiting, burns, and other conditions.
• The greater and more rapid the blood loss, the more severe the shock symptoms.
• Myocardial Infarction (heart attack)
• Myocarditis � a condition in which the heart does not pump properly because the heart muscle is inflamed and diseased
• Valvular Heart Disease �damage to heart valves interrupts blood flow
• Cardiac Arrhythmias �severe irregular heart rhythms cause uncoordinated blood flow through the heart
• Post-cardiac surgery requiring prolonged cardioplegia/cardiopulmonary bypass
• Severe valvular heart disease, particularly aortic stenosis
• Suppression of myocardial contractility by drugs, eg ß-blockers; or metabolic disturbance, eg acidosis, hypo or hyperkalaemia, hypocalcaemia
• Pericardial tamponade/severe constrictive pericarditis
• Acute, severe pulmonary embolism
• Myocardial suppression due to bacteraemia/sepsis (although, strictly speaking, this would be defined as septic shock)
• Systolic - Beta-blocker overdose, calcium channel blocker overdose, myocardial contusion, respiratory acidosis, hypocalcemia, hypophosphatemia, and cardiotoxic drugs (eg, doxorubicin [Adriamycin])
• Diastolic - Ventricular hypertrophy and restrictive cardiomyopathies
• After load - Aortic stenosis, hypertrophic cardiomyopathy, dynamic outflow obstruction, aortic coarctation, and malignant hypertensio

Symptoms of Cardiogenic Shock

Some major symptoms of Cardiogenic Shockfollows:

• Rapid breathing
• Anxiety or agitation
• Cool, clammy skin
• Weakness
• Pale skin color (pallor)
• Sweating , moist skin
• Decreased or no urine output
• Low blood pressure
• Unconsciousness
• Chest pain
• Nausea and vomiting
• Dyspnoea
• Profuse sweating
• Confusion/disorientation
• Palpitations
• Faintness/syncope

Treatment of Cardiogenic Shock

Dopamine, dobutamine, epinephrine, norepinephrine, amrinone, or other medications may be required to increase blood pressure and heart functioning. Pain medicine may be given if necessary. Bed rest is recommended to reduce demands on the heart.The patient may require intraaortic balloon pump therapy, ventricular assistive device, or might ultimately require cardiac transplant. Because of the heart's inability to deliver sufficient oxygen-rich blood to the tissues, the doctor will boost your oxygen supply. It is given either through a mask or nasal prongs. Some treatment of Cardiogenic Shock:

• All patients require intravenous access, high-flow oxygen administered by mask, and cardiac monitoring.
• Twelve-lead electrocardiography performed in the field by appropriately trained paramedics may be useful in decreasing door to PCI times and/or thrombolytics because acute ST-segment elevation myocardial infarctions can be identified earlier.
• The ED physician, can thus be alerted, and may mobilize the appropriate resources.
• Keep the person comfortable and warm (to avoid hypothermia).
• Have the person lie flat with the feet lifted up about 12 inches to increase circulation. However, if the person has from a head, neck, back, or leg injury, leave him or her in the position in which they were found unless doing so poses other immediate danger.
• Do not give fluids by mouth.
• Medicines such as dopamine , dobutamine, epinephrine, and norepinephrine may be needed to increase blood pressure and the amount of blood pumped out of the heart
• Careful monitoring in an intensive care unit is necessary. Further treatment depends on the cause. Fluids and medications given intravenously (through a vein directly into the bloodstream) are used to maintain blood flow.

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