Cardiogenic shock occurs when the heart is unable to pump as much blood as the body needs to function properly. There are different causes for this, but the symptoms are the same. Find out what may be causing cardiogenic shock and what it is being treated for.
Cardiogenic shock occurs when the heart has been damaged so much that it is unable to pump enough oxygen-rich blood to the organs of the body.Due to impaired ejection function, blood pressure begins to decline and the process of multi-organ failure begins, which is a direct threat to life.
Cardiogenic shockis considered to be the most dangerous complication after acute myocardial infarction. Research shows that this type of shock develops in 7-7.5 percent of people with a myocardial infarction (USA, Worcester Heart Attack Study).
Cardiogenic shock most often occurs in men.However, if it is a consequence of a heart attack, it usually occurs in women.
Cardiogenic shock - causes
According to data fromShock Trial Registry,the most common cause of developing cardiogenic shock is left ventricular systolic failure (78.5% of cases), most often as a result of a heart attack.
Less frequent causes include acute mitral regurgitation (6.9%), ventricular septal rupture (3.9%), isolated right ventricular failure (2.8%), tamponade, and cardiac rupture (1.4%).
Other disorders that prevent the heart from effectively pumping blood into the arteries, leading to cardiogenic shock, include:
- acute myocarditis
- endocarditis
- abnormal heart rhythm (ventricular tachycardia, ventricular fibrillation or supraventricular tachycardia)
- myxoma, atrial thrombus
- stenosis of the valve orifice
- massive pulmonary embolism
- aortic dissecting aneurysm
- progressive cardiomopathy
- ventricular septal defect
- traumatic heart injury
- heart transplant rejection
- heart failure after cardiac surgery
An overdose of the drug can also affect the heart's pumping ability and lead to cardiogenic shock. Applies toespecially beta blockers or calcium antagonists.
This will be useful to youCardiogenic shock risk factors
The elderly, people with diabetes, after a heart attack, with an extensive infarction and / or with symptoms of haemodynamic disorders are particularly at risk of developing shock as a complication of myocardial infarction. Risk factors for this type of shock include long-untreated valve disease or the deposition of cholesterol in the coronary arteries.
Cardiogenic shock - symptoms
Symptoms of cardiogenic shockconsist of the symptoms of shock and the symptoms of the underlying disease which is the cause of the shock. The symptoms of shock include disorders that result from insufficient supply of oxygen and other components necessary for the proper functioning of the body.
In turn, the symptoms of the underlying disease depend on the type of cardiac disorder we are dealing with.
Cardiogenic shockcharacterized by
- significant hypotension, i.e. lower blood pressure (systolic blood pressure below 90 mmHg)
- increased wedge pressure (over 20 mmHg)
However, it is not always possible to check the above values, so it is worth knowing the symptoms of cardiogenic shock, which can be recognized in every situation.
First of all, pay attention to the symptoms of hypoperfusion, i.e. symptoms of reduced blood flow:
- in the case of renal hypoperfusion, it will be oliguria ( <500 ml w ciągu 24 godzin)
- in the case of central nervous system hypoperfusion, the characteristic symptoms will be:
- anxiety - loss of alertness and ability to concentrate - deterioration of logical contact (slurred speech) - excessive sleepiness
- in the case of skin hypoperfusion, pale, cool skin appears (pay attention to cold limbs), often with a bluish tinge, which is caused by contraction of the subcutaneous vessels (blue lips and ears are characteristic, and after pinching the nail / fingertip fading takes more than 2 seconds)
In addition, profuse cold sweats and rapid breathing appear. Normally, a person should breathe at a frequency of about 12-20 breaths per minute, but in a shocked state this value may increase (it is best to estimate it by counting the number of breaths per minute).
General weakness is also characteristic of the shock.
In the course of cardiogenic shock, the shock symptoms overlap with the symptoms of the underlying disease, which is the cause of the shock. In the case of aortic infarction and dissection, this will be chest pain, ain case of heart rhythm disturbances, a feeling of uneven beating.
Dyspnea is a sign that pulmonary embolism is the cause of cardiogenic shock.
Cardiogenic shock - first aid
First aid in cardiogenic shock,provided as soon as possible after the onset of symptoms of abnormal heart beat, significantly increases the chances of survival.
Symptoms of cardiogenic shock include :
- sweating,
- pale skin,
- weak pulse,
- quick breath,
- cool hands and feet.
There may also be chest pain, a feeling of uneven beating or shortness of breath. Thanks to the knowledge of these symptoms, one can easily recognizecardiogenic shockand provide first aid to the patient in the appropriate way.
1. If the sick person is conscious, loosen his tight clothing around the neck and waist to make it easier for him to breathe. If there is a shock in the apartment, open the window. Then, if possible, place the patient in a position that relieves the heart, i.e. with a slightly elevated torso.
2. After the patient is stabilized, you can call the ambulance service. Until medical assistance arrives, keep in touch with the patient, soothe them and check that they are breathing.
3. If the injured person is unconscious, place him / her in the recovery position.
4. Due to the fact that the body temperature drops during cardiogenic shock, the patient must be protected against heat loss, preferably with a thermal blanket, but a jacket or coat will also suffice.
5. The cause of cardiogenic shock is heart failure, therefore the patient's condition may deteriorate at any time. If there is a cardiac arrest, no heart rate is felt, and the patient stops breathing, initiate CPR (heart massage and artificial respiration).
Worth knowingRaising the legs is not allowed when the victim faints, is unconscious, and when there is a suspicion of head, spine, pelvic, lower limb, abdominal, chest injuries, and when the victim experiences severe shortness of breath.
Cardiogenic shock - diagnosis
A number of tests are used in the diagnosis of cardiogenic shock. The basic ones include blood pressure measurement and blood tests, which can help you determine, for example, whether you have developed metabolic acidosis or severe damage to your heart tissue.
Then, non-invasive imaging tests are performed, such as:
- Chest X-ray - wideningmediastinum may indicate tamponade, and interstitial pulmonary edema may indicate left ventricular failure
- electrocardiogram (EKG) - the test can detect abnormal heart rhythms, such as ventricular tachycardia or fibrillation, which may cause cardiogenic shock
- echocardiography - provides an image of the blood flow
The only invasive test is the so-called Swan-Ganz catheter, or pulmonary artery catheterization. The test is performed to measure how much blood the heart pumping.
Cardiogenic shock - treatment
Two treatments are modern forms of therapy: PCI and CABAG. PCI, or percutaneous coronary intervention, is a procedure for widening or restoring the endocrine arteries with the use of instruments inserted through the skin. On the other hand, CABAG, i.e. coronary artery bypass, is a cardiac surgery that involves the implantation of vascular bypass grafts that bypass the place of stenosis in the coronary artery.
Another form of treatment of patients after cardiogenic shock is intra-aortic counterpulsation (IABP), which consists in introducing a balloon into the aorta, through the femoral artery, and then inflating and emptying it in the appropriate phases of the heart, thanks to synchronization of the pump with the ECG record .
If the cause of the shock is arrhythmia, the doctor may use arrhythmic drugs or perform electrical cardioversion, which is a procedure to restore the normal heart rhythm with the use of current.
Cardiogenic shock - prognosis
Cardiogenic shock is still associated with high mortality, mainly among patients with heart attack.40-60% of patients die within 30 days of this complication. patients.
Diagnosis and treatment of cardiogenic shock
The basic examination in cardiogenic shock is cardiac imaging - echocardiography. In many cases, it is this research that shows what causes cardiogenic shock. Determining the cause, in turn, determines the treatment of cardiogenic shock.
This will be useful to youHow can I prevent cardiogenic shock?
The risk of the causes of shock, i.e. cardiovascular diseases, should be minimized. For this purpose, it is necessary, first of all, to prevent the development of obesity and hypertension, as well as an increase in blood cholesterol levels. Quitting smoking is also important in preventing cardiogenic shock.