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Cardiogenic shock
Classification and external resources
ICD-10 R57.0
ICD-9 785.51
DiseasesDB 29216
MedlinePlus 000185
eMedicine med/285
MeSH D012770

Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively.[1][2][3][4] [5]

Since this is numerous category of shock there is insufficient perfusion of tissue (i.e. the heart) to meet the required demand for oxygen and nutrients. This leads to cell death from oxygen starvation (hypoxia) and nutrient starvation (eg hypoglycemia).[6][7] Because of this it may lead to cardiac arrest (or circulatory arrest) which is an acute cessation of cardiac pump function.[4]

Cardiogenic shock is defined by sustained hypotension with tissue hypoperfusion despite adequate left ventricular filling pressure. Signs of tissue hypoperfusion include oliguria (<30 mL/h), cool extremities, and altered level of consciousness.

Contents

Etiology

Cardiogenic shock is caused by the failure of the heart to pump effectively. It can be due to damage to the heart muscle, most often from a large myocardial infarction. Other causes include arrhythmia, cardiomyopathy, cardiac valve problems, ventricular outflow obstruction (i.e. aortic valve stenosis, aortic dissection, systolic anterior motion (SAM) in hypertrophic cardiomyopathy), ventriculoseptal defects or medical error.[1][2][4][3][5][8][9]

Signs and symptoms

  • Anxiety, restlessness, altered mental state due to decreased cerebral perfusion and subsequent hypoxia.
  • Hypotension due to decrease in cardiac output.
  • A rapid, weak, thready pulse due to decreased circulation combined with tachycardia.
  • Cool, clammy, and mottled skin (cutis marmorata), due to vasoconstriction and subsequent hypoperfusion of the skin.
  • Distended jugular veins due to increased jugular venous pressure.
  • Oliguria (low urine output) due to insufficient renal perfusion if condition persists.
  • Rapid and deep respirations (hyperventilation) due to sympathetic nervous system stimulation and acidosis.
  • Fatigue due to hyperventilation and hypoxia.
  • Absent pulse in tachyarrhythmia.
  • Pulmonary edema, involving fluid back-up in the lungs due to insufficient pumping of the heart..

Diagnosis

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Electrocardiogram

An electrocardiogram helps establishing the exact diagnosis and guides treatment, it may reveal:

Radiology

Echocardiography may show poor ventricular function, signs of PED, ventricular septal rupture (VSR), an obstructed outflow tract or cardiomyopathy.

Swan-ganz catheter

The Swan-ganz catheter or Pulmonary artery catheter may assist in the diagnosis by providing information on the hemodynamics.

Biopsy

In case of suspected cardiomyopathy a biopsy of heart muscle may be needed to make a definite diagnosis. but biopsy should only be done when third space is suspected

Treatment

In cardiogenic shock: depending on the type of myocardal infarction one can infuse fluids or in shock refractory to infusing fluids inotropica. In case of cardiac arrhythmia several anti-arrhythmic agents may be administered, i.e. adenosine, verapamil, amiodarone, β-blocker or glucagon.[10] Positive inotropic agents, which enhance the heart's pumping capabilities, are used to improve the contractility and correct the hypotension. Should that not suffice an intra-aortic balloon pump (which reduces workload for the heart, and improves perfusion of the coronary arteries) can be considered or a left ventricular assist device (which augments the pump-function of the heart).[1][2][3]

Cardiogenic shock may be treated with intravenous dobutamine, which acts on β1 receptors of the heart leading to increased contractility and heart rate. [11]

References

  1. ^ a b c Rippe, James M.; Irwin, Richard S. (2003). Irwin and Rippe's intensive care medicine. Philadelphia: Lippincott Williams & Wilkins. ISBN 978-0-7817-3548-3. OCLC 53868338.  
  2. ^ a b c Marino, Paul L. (1998). The ICU book. Baltimore: Williams & Wilkins. ISBN 978-0-683-05565-8. OCLC 300112092.  
  3. ^ a b c Society of Critical Care Medicine. (2001). Fundamental Critical Care Support. Society of Critical Care Medicine. ISBN 978-0-936145-02-0. OCLC 48632566.  
  4. ^ a b c Textbooks of Internal Medicine
  5. ^ a b Shock: An Overview PDF by Michael L. Cheatham, MD, Ernest F.J. Block, MD, Howard G. Smith, MD, John T. Promes, MD, Surgical Critical Care Service, Department of Surgical Education, Orlando Regional Medical Center Orlando, Florida
  6. ^ Chelliah YR (December 2000). "Ventricular arrhythmias associated with hypoglycaemia". Anaesthesia and Intensive Care 28 (6): 698–700. PMID 11153301.  
  7. ^ Navarro-Gutiérrez S, González-Martínez F, Fernández-Pérez MT, García-Moreno MT, Ballester-Vidal MR, Pulido-Morillo FJ (December 2003). "Bradycardia related to hypoglycaemia". European Journal of Emergency Medicine 10 (4): 331–3. doi:10.1097/01.mej.0000103764.80742.76 (inactive 2009-08-13). PMID 14676515.  
  8. ^ Cardiogenic shock Department of Anaesthesia and Intensive Care of The Chinese University of Hong Kong
  9. ^ Introduction to management of shock for junior ICU trainees and medical students Department of Anaesthesia and Intensive Care of The Chinese University of Hong Kong
  10. ^ Hall-Boyer K, Zaloga GP, Chernow B (July 1984). "Glucagon: hormone or therapeutic agent?". Critical Care Medicine 12 (7): 584–9. PMID 6375966.  
  11. ^ Rang and Dale's Pharmacology, H.P. Rang, M.M. Dale, J.M.Ritter, R.J. Flower, Churchhill Livingston, Elsevier, 6th Edition

External links


Study guide

Up to date as of January 14, 2010

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Shock is defined as an inability of the heart to pump enough blood to the systemic circulation such that vital organs of the body are not perfused. This is due to insufficient pumping of the heart. Can be the result of a heart attack or congestive heart failure (CHF).


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