Cardiogenic Shock is a life-threatening condition in which the heart cannot supply enough blood to the body. Symptoms of cardiogenic shock include extreme fatigue, shortness of breath, decreased urination, and confusion. This serious condition requires prompt treatment for the best chance of survival.
This article discusses the causes, treatment, and prognosis of cardiogenic shock.
What is shock?
Shock is a state of very low blood pressure that affects the blood supply to organs. due to infection (septic shock), allergic reactions (allergic shock), brain injury (neurogenic shock), or bleeding (hypovolemia Shock).
Cardiogenic shock is shock caused by the inability of the heart to provide blood flow.
The heart acts as a pump, supplying nutrients and oxygen throughout the body. Cardiac output is the flow of blood pumped by the heart every minute. In cardiogenic shock, cardiac output is low, leading to hypotension and multiple organ failure.
Cardiogenic shock symptoms
Signs and symptoms of cardiogenic shock associated with low cardiac output include:
- extreme fatigue
- loss of consciousness
- low blood pressure
- shortness of breath
- decreased urination
- pale skin
- cold limbs
What causes cardiogenic shock?
Cardiogenic shock can have a variety of causes:
- Heart attack (the most common cause, accounting for 80% of cases)
- heart failure of any cause
- Cardiac tamponade (fluid in the sac surrounding the heart)
- myocarditis (inflammation of the heart)
- serious heart valve problems
- Arrhythmia (heart rhythm problem)
- Drug overdose, such as beta-blockers or calcium channel blockers (drugs that lower blood pressure)
Diagnosing cardiogenic shock
Cardiogenic shock should be considered when blood pressure is low and unresponsive to intravenous fluids. Some tests can help differentiate cardiogenic shock from other types of shock.
Laboratories, such as cardiac biomarkers, include: Troponin (a protein found in the heart muscle) and BNP (B-type natriuretic peptide, a hormone produced by the heart) are elevated in cardiogenic shock. Other labs showed signs of organ damage, such as acute kidney injury and liver damage.
Blood tests also often show acidosis (a state in which body fluids are too acidic) and elevated levels of lactate (produced mainly in muscle cells and red blood cells).
Cardiac imaging, including Transthoracic echocardiography, is one of the most important diagnostic procedures for cardiogenic shock. Echocardiography shows the pumping function and valves of the heart and excludes cardiac tamponade.
When necessary, confirm the diagnosis of cardiogenic shock with an invasive procedure called the right heart catheterizationDuring this procedure, a tube called a catheter is placed in a vein and into the right chamber of the heart. This measures pressure and calculates cardiac output.
Treating cardiogenic shock begins with correcting the underlying cause. In general, treatment requires some level of care in the Intensive Care Unit (ICU) or Coronary Care Unit (CCU), including the following:
- Heart attacks are treated with medication and stents are placed in blocked coronary arteries.
- tamponade is treated by removing fluid from the sac around the heart, called Pericardiocentesis.
- for some forms of myocarditis corticosteroids.
- Heart valve problems may require surgery.
called drugs cardiac (Such as Milrinone and dobutamine) can be used to help improve the pumping function of the heart. vasopressor like Norepinephrine Blood pressure may need to be raised.
Some patients with cardiogenic shock need Intubation (breathing tube) for mechanical ventilation. This helps maintain oxygen levels and takes over the job of breathing.
Sometimes, special equipment is needed temporarily to help supply blood to the body. These are called mechanical circulatory support devices and are placed by cardiologists (specialists who treat heart and blood vessel disease) or cardiothoracic surgeons (specialists who deal with organs in the chest, including the heart, lungs, and esophagus).
Examples of mechanical support devices include:
- intra-aortic Balloon pump
- Left Ventricular Assist Devices (LVADs) such as Impella and TandemHeart
- extracorporeal membrane oxygenation (ECMO)
When cardiogenic shock does not improve, permanent left ventricular support device (LVAD) and heart transplantation may be required.
Cardiogenic shock is a very serious diagnosis with a poor prognosis. Unfortunately, survival rates are low.
However, new team-based methods and techniques appear promising. One hospital implemented a standardized team-based approach to the treatment of cardiogenic shock and found that three-quarters (75%) of those who survived more than a month had improved outcomes.
Cardiogenic shock is a serious, life-threatening condition in which the heart does not function adequately. This can lead to organ failure and possibly death. Medications, medical procedures, and devices are used to treat cardiogenic shock.
Hearing that your loved one has been diagnosed with cardiogenic shock can be overwhelming. In addition to worrying about your loved ones, you may face pressure to stay in the ICU, communicate with healthcare providers, and make decisions on behalf of patients.
Know that the medical team is working together to provide the best possible care. Do your best to stay rested, make sure to eat and stay hydrated, rest outdoors, and seek support from family and friends that can help during this difficult time.