Cardiogenic shock

Description

Cardiogenic shock is a life-threatening condition in which your heart suddenly can't pump enough blood to meet your body's needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock.

Cardiogenic shock is rare. It is often fatal if not treated immediately. When treated immediately, about half the people who develop the condition survive.

Symptoms

Cardiogenic Shock signs and symptoms include:

  • Rapid breathing
  • Severe shortness of breath
  • Sudden, rapid heartbeat (tachycardia).
  • Loss of consciousness
  • Weak pulse
  • Low blood pressure (hypotension)
  • Sweating
  • Pale skin
  • Cold hands or feet
  • Urinating less than usual or not at all

The symptoms of a heart attack

Because cardiogenic shock usually occurs in people who are having a serious heart attack, it is important to know the signs and symptoms of a heart attack. These include:

  • Pressure, fullness or squeezing pain in the center of the chest that lasts more than a couple of minutes
  • Pain spreading to the shoulder, one or both of your arms, your back, or even the teeth and jaw
  • Increasing episodes of chest pain
  • Shortness of breath
  • Sweating
  • Lightheadedness or sudden dizziness
  • Nausea and vomiting

Seek medical attention quickly when you have these signs or symptoms, to decrease your risk of developing cardiogenic shock.

When to see a doctor

Get heart attack treatment quickly improves the chances of survival and reduces the damage to your heart. If you are having symptoms of a heart attack, call 911 or other emergency medical services for help. If you do not have access to emergency medical services, have someone drive you to the nearest hospital. Do not drive yourself.

Causes

In most cases, a lack of oxygen to your heart, usually from a heart attack, damage, its main pumping chamber (left ventricle). Without oxygen-rich blood flowing to that area of your heart, the heart muscle can weaken and enter in cardiogenic shock.

Rarely, damage to your heart, the right ventricle, which sends blood to the lungs to receive oxygen, leading to cardiogenic shock.

Other possible causes of cardiogenic shock include:

  • Inflammation of the heart muscle (myocarditis)
  • The infection of the heart valves (endocarditis)
  • Heart weakened by any cause
  • The drug overdose or poisoning with substances that can affect your heart's pumping ability

Risk factors

If you have a heart attack, your risk of developing cardiogenic shock increases if you:

  • They are older
  • Have a history of heart failure or a heart attack
  • Have locks (coronary heart disease) in several of your heart's main arteries
  • Have diabetes or high blood pressure
  • Are women

Complications

If not treated immediately, cardiogenic shock can lead to death. Another serious complication is damage to your liver, kidneys, or other organs of the lack of oxygen, which can be permanent.

Prevention

The best way to prevent cardiogenic shock is to make lifestyle changes to maintain the health of your heart and blood pressure under control.

  • Do not smoke and avoid second-hand smoke. If you smoke, the best way to reduce your risk of heart attack is to stop smoking.
  • Maintain a healthy weight. Excess weight contributes to other risk factors of heart attack and cardiogenic shock, such as high blood pressure, cardiovascular disease, and diabetes. Losing just 10 pounds (4.5 kilograms) can lower blood pressure and improve cholesterol levels.
  • Eat less cholesterol and saturated fat. The limitation of these, especially saturated fat, can reduce your risk of heart disease. Avoid trans fats.
  • Use less salt. Excess salt (sodium), leads to the accumulation of fluid in the body, which can strain the heart. Less than 2,300 milligrams (mg) of sodium a day. The salt can be found in many canned and processed products, so that is a good idea to check the labels of the food.
  • Reduce the amount of sugar. This will help avoid poor in nutrients, calories, and help you maintain a healthy weight.
  • Limit the consumption of alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink per day for women and up to two drinks per day for men.
  • Exercise regularly. Exercise can lower your blood pressure and improve the overall health of your blood vessels and the heart. Get at least 150 minutes of moderate aerobic activity or 75 minutes of aerobic activity, vigorous week, or a combination of moderate and vigorous activity. It is recommended that you spread out this exercise during the course of a week. Greater amounts of exercise will provide greater benefits to your health.

If you have a heart attack, quick action may help prevent cardiogenic shock. Get emergency medical help if you think you're having a heart attack.

Cardiogenic shock

Diagnosis

Cardiogenic shock is usually diagnosed in an emergency setting. The doctors will verify if there are signs and symptoms of shock, and then perform tests to find the cause. Tests may include:

  • Measurement of the blood pressure. The people in a state of shock have a very low blood pressure.
  • Electrocardiogram (ECG or EKG). This fast, non-invasive, the test records the electrical activity of your heart through electrodes attached to your skin. If you have the heart muscle is damaged or accumulation of fluid around your heart, the heart does not send electrical signals normally.
  • X-ray of the chest. A chest x-ray shows the size and shape of your heart and if there is fluid in the lungs.
  • Blood tests. You're going to have to draw blood to check for organ damage, infection, and heart attack. An arterial blood gas analysis may be done to measure oxygen in the blood.
  • The echocardiogram. The sound waves produce an image of the heart. This test can help to identify the damage of a heart attack.
  • Cardiac catheterization (angiography). This test can reveal blocked or narrowing of the arteries. A doctor inserts a long, thin tube (catheter) through an artery in the leg or the wrist and leads her to his heart. Contrast dye flows through the catheter, causing the arteries easier to see on x-rays.

Treatment

Cardiogenic Shock treatment focuses on the reduction of the damage caused by lack of oxygen to your heart and other organs.

Emergency life support

Most people who have cardiogenic shock need extra oxygen. If necessary, you will be connected to a breathing machine (ventilator). You will receive medications and fluid through an IV in the arm.

Drugs

Fluids and plasma are administered through an IV. Medications to treat cardiogenic shock are given to increase its pumping capacity of the heart and reduce the risk of blood clots.

  • Vasopressors. These medications are used to treat low blood pressure. They include dopamine, epinephrine (Adrenaline, Auvi-Q), norepinephrine (Levophed), and others.
  • Inotropic agents. These medications, which help to improve the pumping function of the heart, can be given up to other treatments you start working. They include dobutamine, dopamine and milrinone.
  • The aspirin. Aspirin is usually given immediately to reduce the clotting of the blood and prevent blood moves through a narrowed artery. Take an aspirin to himself while waiting for help to arrive only if your doctor has previously reported to do so to the symptoms of a heart attack.
  • Antiplatelet medication. The emergency room doctors may give you aspirin-like medications to help prevent new clots from forming. These drugs include clopidogrel (Plavix), tirofiban (Aggrastat), and eptifibatide (Integrilin).
  • Other blood-thinning medications. It is likely that you may be given other medications, such as heparin, to make your blood less likely to form clots. IV or heparin injection is usually given during the first few days after a heart attack.

Surgeries and other procedures

Medical procedures to treat cardiogenic shock usually focus on restoring the flow of blood through the heart. They include:

  • Angioplasty and stent placement.If a blockage is found during a cardiac catheterization, your doctor may insert a long, thin tube (catheter) equipped with a special balloon through an artery, usually in the leg, to a blocked artery in his heart. Once in position, the balloon is briefly inflated to open the lock. A metal mesh stent may be inserted into the artery to keep it open over time. In most cases, the doctor must place a stent coated with a slow-releasing medication to help keep the artery open.
  • The balloon pump. The doctor inserts a balloon pump in the main artery of the heart (aorta). The pump inflates and deflates within the aorta, helping the blood to flow and take some of the workload off of your heart.
  • Extracorporeal membrane oxygenation (ECMO) . extracorporeal membrane oxygenation (ECMQ) helps to improve the flow of blood and oxygen to the body. The blood is pumped out of your body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood to the tissues in the body.

Angioplasty and stent placement. If a blockage is found during a cardiac catheterization, your doctor may insert a long, thin tube (catheter) equipped with a special balloon through an artery, usually in the leg, to a blocked artery in his heart. Once in position, the balloon is briefly inflated to open the lock.

A metal mesh stent may be inserted into the artery to keep it open over time. In most cases, the doctor must place a stent coated with a slow-releasing medication to help keep the artery open.

If medications and other procedures don't work to treat cardiogenic shock, your doctor may recommend surgery.

  • Coronary artery bypass surgery. This surgery uses a healthy blood vessel from your leg, arm or chest to create a new pathway for the blood, for the flow around a blockage or narrowing of the arteries. Your doctor may suggest surgery after your heart has had time to recover from his heart attack. Sometimes, the bypass surgery is done as an emergency treatment.
  • The surgery to repair an injury in his heart. Sometimes an injury, like a tear in one of the chambers of your heart, or a heart valve is damaged, it can cause cardiogenic shock. Surgery can correct the problem.
  • Ventricular assist device (VAD). A mechanical device that can be implanted in the abdomen and attached to the heart to help it pump. A ventricular assist device (VAD) to extend and improve the lives of some people with end-stage heart failure who are waiting for new hearts, or are not able to have a heart transplant.
  • Heart transplant. If your heart is so damaged that other treatments do not work, a heart transplant may be a last resort.
Symptoms and treatment of Cardiogenic shock