Cardiogenic Shock - Definition, Causes, Symptoms and Treatment

Cardiogenic shock has a death rate of about 60% andincidence of cardiogenic shock is higher in men
is the major cause of death in patients hospitalized forcompared to women because of the increased
a heart attack.prevalence of coronary artery disease in males.
Cardiogenic shock is characterized by a decreasedCardiogenic shock can be caused by disorders of the
pumping ability of the heart that causes a shocklikeheart muscle, the valves, or the heart's electrical
state (ie, global hypoperfusion). It most commonlyconduction system. Cardiogenic shock is life
occurs in association with, and as a direct result of,threatening and requires emergency medical treatment.
acute myocardial infarction (AMI). The most commonDopamine, dobutamine, epinephrine, norepinephrine,
cause of cardiogenic shock is extensive acuteamrinone, or other medications may be required to
myocardial infarction, although a smaller infarction in aincrease blood pressure and heart functioning.
patient with previously compromised left ventricularEchocardiography may show arrhythmia, signs of PED,
function may also precipitate shock. Cardiogenic shockventricular septal rupture (VSR), an obstructed outflow
is defined by sustained hypotension with tissuetract or cardiomyopathy. Pain medicine may be given if
hypoperfusion despite adequate left ventricular fillingnecessary. Bed rest is recommended to reduce
pressure. Signs of tissue hypoperfusion include oliguria.demands on the heart. Coronary artery bypass
Cardiogenic shock is characterized by both systolicgrafting. In this surgery, arteries or veins from other
and diastolic dysfunction. Patients who developparts of the body are used to bypass (that is, go
cardiogenic shock from acute MI consistently havearound) narrowed coronary arteries. The use of the
evidence of progressive myocardial necrosis withIABP reduces systolic left ventricular afterload and
infarct extension. Decreased coronary perfusionaugments diastolic coronary perfusion pressure,
pressure and increased myocardial oxygen demandthereby increasing cardiac output and improving
play a role in the vicious cycle that leads to cardiogeniccoronary artery blood flow. Heart monitoring, including
shock.hemodynamic monitoring, to guide treatment.
Cardiogenic shock occurs in 8.6% of patients withTreatment for Cardiogenic Shock Tips
ST-segment elevation MI with 29% of those1. Inotropic medications should be considered in
presenting to the hospital already in shock. It occurssystems with appropriately trained paramedical
only in 2% of non-ST-segment elevation MI. Outcomespersonnel.
significantly improve only when rapid revascularization2. In case of cardiac arrhythmia several anti-arrhythmic
can be achieved. The recent SHOCK trialagents may be administered, i.e. adenosine, verapamil,
demonstrated that overall mortality whenamiodarone, ß-blocker.
revascularization occurs is 38%. When rapid3. Balloon angioplasty (PTCA) may be an alternative to
revascularization is not attempted, mortality ratessurgery in some cases.
approach 70%. Cardiogenic shock can also be caused4. Oxygen reduces the workload of the heart by
by mechanical complications-such as acute mitralreducing tissue demands for blood flow.
regurgitation, rupture of the interventricular septum, or5. Heart monitoring, including hemodynamic monitoring,
rupture of the free wall-or by large right ventricularto guide treatment
infarctions. Myocardial ischemia causes a decrease in6. Coronary artery bypass grafting. In this surgery,
contractile function, which leads to left ventriculararteries or veins from other parts of the body are
dysfunction and decreased arterial pressure; these, inused to bypass (that is, go around) narrowed coronary
turn, exacerbate the myocardial ischemia. The overallarteries.