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Cardiogenic shock

 

 
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Cardiogenic shock
 
 
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Cardiogenic shock is based upon an inadequate circulation of blood
Blood

Blood is a specialized bodily fluid that delivers necessary substances to the body's Cell s ? such as nutrients and oxygen ? and transports waste products away from those same cells....
 due to primary failure of the ventricle
Ventricle (heart)

In the heart, a ventricle is a heart chamber which collects blood from an atrium and pumps it out of the heart.In a four-chambered heart, such as that in humans, there are two ventricles: the right ventricle pumps blood into the pulmonary circulation for the lungs, and the left ventricle pumps blood into the systemic cir...
s of the heart
Heart

The heart is a muscle organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods....
 to function effectively.


Since this is a category of shock there is insufficient perfusion
Perfusion

In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. The word is derived from the French verb "perfuser" meaning to "pour over or through."...
 of tissue
Biological tissue

Tissue is a cellular organizational level intermediate between cells and a complete organism. Hence, a tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function....
 (i.e. the heart
Heart

The heart is a muscle organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods....
) to meet the required demand for oxygen
Oxygen

Oxygen no O2 produced; 2) O2 produced, but absorbed in oceans & seabed rock; 3) O2 starts to gas out of the oceans, but is absorbed by land surfaces and formation of ozone layer; 4-5) O2 sinks filled and the gas accumulates]]...
 and nutrients. This leads to cell
Cell (biology)

The cell is the structural and functional unit of all known Life organisms. It is the smallest unit of an organism that is classified as living, and is often called the building bricks of life....
 death from oxygen
Oxygen

Oxygen no O2 produced; 2) O2 produced, but absorbed in oceans & seabed rock; 3) O2 starts to gas out of the oceans, but is absorbed by land surfaces and formation of ozone layer; 4-5) O2 sinks filled and the gas accumulates]]...
 starvation, hypoxia
Hypoxia (medical)

Hypoxia is a Pathology condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise....
. Because of this it may lead to cardiac arrest
Cardiac arrest

A cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during Systole ....
 (or circulatory arrest) which is an acute cessation of cardiac pump function.

Cardiogenic shock is defined by sustained hypotension with tissue hypoperfusion despite adequate left ventricular filling pressure.






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Cardiogenic shock is based upon an inadequate circulation of blood
Blood

Blood is a specialized bodily fluid that delivers necessary substances to the body's Cell s ? such as nutrients and oxygen ? and transports waste products away from those same cells....
 due to primary failure of the ventricle
Ventricle (heart)

In the heart, a ventricle is a heart chamber which collects blood from an atrium and pumps it out of the heart.In a four-chambered heart, such as that in humans, there are two ventricles: the right ventricle pumps blood into the pulmonary circulation for the lungs, and the left ventricle pumps blood into the systemic cir...
s of the heart
Heart

The heart is a muscle organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods....
 to function effectively.


Since this is a category of shock there is insufficient perfusion
Perfusion

In physiology, perfusion is the process of nutritive delivery of arterial blood to a capillary bed in the biological tissue. The word is derived from the French verb "perfuser" meaning to "pour over or through."...
 of tissue
Biological tissue

Tissue is a cellular organizational level intermediate between cells and a complete organism. Hence, a tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function....
 (i.e. the heart
Heart

The heart is a muscle organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods....
) to meet the required demand for oxygen
Oxygen

Oxygen no O2 produced; 2) O2 produced, but absorbed in oceans & seabed rock; 3) O2 starts to gas out of the oceans, but is absorbed by land surfaces and formation of ozone layer; 4-5) O2 sinks filled and the gas accumulates]]...
 and nutrients. This leads to cell
Cell (biology)

The cell is the structural and functional unit of all known Life organisms. It is the smallest unit of an organism that is classified as living, and is often called the building bricks of life....
 death from oxygen
Oxygen

Oxygen no O2 produced; 2) O2 produced, but absorbed in oceans & seabed rock; 3) O2 starts to gas out of the oceans, but is absorbed by land surfaces and formation of ozone layer; 4-5) O2 sinks filled and the gas accumulates]]...
 starvation, hypoxia
Hypoxia (medical)

Hypoxia is a Pathology condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise....
. Because of this it may lead to cardiac arrest
Cardiac arrest

A cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during Systole ....
 (or circulatory arrest) which is an acute cessation of cardiac pump function.

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 mentation.

Etiology

Cardiogenic shock is caused by the failure of the heart to pump effectively. It can be due to damage to the heart
Heart

The heart is a muscle organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods....
 muscle, most often from a large myocardial infarction
Myocardial infarction

Myocardial infarction , commonly known as a heart attack, occurs when the Blood flow to part of the heart is interrupted. This is most commonly due to occlusion of a coronary artery following the rupture of a Vulnerable plaque, which is an unstable collection of lipids and white blood cells in the wall of an artery....
. Other causes include arrhythmia
Cardiac arrhythmia

Cardiac arrhythmia is a term for any of a large and heterogeneous group of conditions in which there is abnormal Electrical conduction system of the heart in the heart....
, cardiomyopathy
Cardiomyopathy

Cardiomyopathy, which literally means "heart muscle disease," is the deterioration of the function of the myocardium for any reason. People with cardiomyopathy are often at risk of arrhythmia or sudden cardiac death or both....
, cardiac valve problems, ventricular outflow obstruction (i.e. aortic valve stenosis
Aortic valve stenosis

Aortic valve stenosis is a valvular heart disease caused by the incomplete opening of the aortic valve.The aortic valve controls the direction of blood flow from the left ventricle to the aorta....
, aortic dissection
Aortic dissection

Aortic dissection is a tear in the wall of the aorta that causes blood to flow between the layers of the wall of the aorta and force the layers apart....
, systolic anterior motion (SAM) in hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy, HCM or HOCM, is a disease of the myocardium in which a portion of the myocardium is left ventricular hypertrophy without any obvious cause....
), ventriculoseptal defects or medical error.

Signs and symptoms

  • Anxiety, restlessness, altered mental state
    Glasgow Coma Scale

    The Glasgow Coma Scale or GCS, sometimes also known as the Glasgow Coma Score is a neurology Scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment....
     due to decreased cerebral perfusion and subsequent hypoxia
    Hypoxia (medical)

    Hypoxia is a Pathology condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise....
    .
  • Hypotension due to decrease in cardiac output
    Cardiac output

    Cardiac output is the volume of blood being pumped by the heart, in particular by a ventricle in a minute. This is measured in dm3 min-1 ....
    .
  • 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 vein
    Jugular vein

    The jugular veins are veins that bring deoxygenated blood from the head back to the heart via the superior vena cava....
    s 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
    Pulmonary edema

    Pulmonary edema , or oedema , is swelling and/or fluid accumulation in the lungs. It leads to impaired gas exchange and may cause respiratory failure....
    , involving fluid back-up in the lungs due to insufficient pumping of the heart.


Diagnosis


Electrocardiogram

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

    Cardiac arrhythmia is a term for any of a large and heterogeneous group of conditions in which there is abnormal Electrical conduction system of the heart in the heart....
    s
  • Signs of cardiomyopathy
    Cardiomyopathy

    Cardiomyopathy, which literally means "heart muscle disease," is the deterioration of the function of the myocardium for any reason. People with cardiomyopathy are often at risk of arrhythmia or sudden cardiac death or both....


Radiology

Echocardiography
Echocardiography

An echocardiogram, often referred to in the medical community as a cardiac ECHO or simply an ECHO, is a sonography of the heart. Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart....
 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
Biopsy

A biopsy is a medical test involving the removal of Cell_s or Biological tissues for examination. It is the removal of tissue from a living subject to determine the presence or extent of a disease....
 of heart muscle may be needed to make a definite diagnosis
Diagnosis

Diagnosis is the identification of the nature of anything, either by process of elimination or other analytical methods. Diagnosis is used in many different disciplines, with slightly different implementations on the application of logic and experience to determine the cause and effect relationships....
.

Treatment

In cardiogenic shock: depending on the type of myocardal infarction one can infuse fluids or in shock refractory to infusing fluids inotropica
Inotrope

An inotrope is an agent that alters the force or energy of muscular contractions. Negatively inotropic agents weaken the force of muscle contractions....
. In case of cardiac arrhythmia
Cardiac arrhythmia

Cardiac arrhythmia is a term for any of a large and heterogeneous group of conditions in which there is abnormal Electrical conduction system of the heart in the heart....
 several anti-arrhythmic agents may be administered, i.e. adenosine
Adenosine

Adenosine is a nucleoside composed of a molecule of adenine attached to a ribose sugar molecule moiety via a ?-N9-glycosidic bond....
, verapamil
Verapamil

Verapamil is an L-type calcium channel blocker of the phenylalkylamine class. It has been used in the treatment of hypertension, angina pectoris, cardiac arrhythmia, and most recently, cluster headaches....
, amiodarone
Amiodarone

Amiodarone is an antiarrhythmic agent used for various types of tachyarrhythmias , both ventricular and supraventricular arrhythmias. Discovered in 1961, it was not approved for use in the United States until 1985....
, ß-blocker
Beta blocker

Beta blockers are a class of medication used for various indications, but particularly for the management of cardiac arrhythmias, cardioprotection after myocardial infarction , and hypertension....
. Positive inotropic agents
Inotrope

An inotrope is an agent that alters the force or energy of muscular contractions. Negatively inotropic agents weaken the force of muscle contractions....
, 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
Intra-aortic balloon pump

The 'Intra-aortic balloon pump' is a mechanical device that is used to decrease myocardial oxygen demand while at the same time increasing cardiac output....
 (which reduces workload
Afterload

[Image:Heart systole.svg|thumb|Ventricular systole. In cardiology physiology, afterload is used to mean the tension produced by a chamber of the heart in order to contraction....
 for the heart, and improves perfusion of the coronary arteries) can be considered or a left ventricular assist device
Ventricular assist device

A Ventricular assist device, or VAD, is a machine that is used to partially or completely replace the function of a failing heart. Some VADs are intended for short term use, typically for patients recovering from myocardial infarction or cardiac surgery, while others are intended for long term use , typically for patients suffering fro...
 (which augments the pump-function of the heart).

Cardiogenic shock may be treated with intravenous dobutamine
Dobutamine

Dobutamine is a sympathomimetic drug used in the treatment of heart failure and cardiogenic shock. Its primary mechanism is direct stimulation of beta receptor of the sympathetic nervous system....
, which acts on ß1 receptors of the heart which causes increased power and heart rate.

External links

  • by eMedicine
    EMedicine

    eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely, two medical doctors. It was sold to WebMD in January 2006....