Cardiogenic shock

From Wikipedia, the free encyclopedia

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.

[edit] 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]

[edit] 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..

[edit] Diagnosis
[edit] Electrocardiogram

An electrocardiogram helps establishing the exact diagnosis and

guides treatment, it may reveal:

• Cardiac arrhythmias
• Signs of cardiomyopathy
[edit] Radiology

Echocardiography may show poor ventricular function, signs of

PED, ventricular septal rupture (VSR), an obstructed outflow
tract or cardiomyopathy.
[edit] Swan-ganz catheter

The Swan-ganz catheter or Pulmonary artery catheter may assist

in the diagnosis by providing information on the hemodynamics.
[edit] 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
 [edit] 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.
 Medication
(Zocor (simvastatin
Zocor is a cholesterol-lowering medication and it can help prevent heart disease

Avoid drinking alcohol while taking Zocor. Alcohol can raise triglyceride levels, and may
also damage your liver while you are taking Zocor
And pregnancy

Zocor side effects

• muscle pain, tenderness, or weakness with fever or flu symptoms and dark
colored urine.
Less serious side effects may include:

• mild stomach pain, gas, bloating, stomach upset, heartburn;

• nausea;
• constipation; or
• diarrhea.

(Plavix(clopidogrel
Plavix is used to prevent blood clots after a recent heart attack or stroke, and in people
.with certain disorders of the heart or blood vessels

Avoid sports or activities that could result in a bruising or bleeding injury. Use extra
caution to avoid cuts when brushing your teeth or shaving.

Avoid drinking alcohol while taking Plavix. Alcohol may increase your risk of bleeding in
your stomach or intestines.

Plavix side effects

• nosebleed or other bleeding that will not stop;

• black, bloody, or tarry stools;
• coughing up blood or vomit that looks like coffee grounds;
• chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea,
sweating, general ill feeling;
• sudden numbness or weakness, especially on one side of the body;
• sudden headache, confusion, problems with vision, speech, or balance; or
• pale skin, easy bruising or bleeding, weakness, fever, and urinating more or
less than usual.
 Rocephin(ceftriaxone
(

Rocephin is used to treat many kinds of bacterial infections, including severe or life-
threatening forms such as meningitis

Do not use Rocephin if you are allergic to ceftriaxone, or to other cephalosporin

antibiotics,

Rocephin is given as an injection into a muscle or a vein.

Rocephin side effects

•
• diarrhea that is watery or bloody;
• fever or chills;
• skin rash, bruising, severe tingling, numbness, pain, muscle weakness
:

Pantoprazole
Pantoprazole is a proton pump inhibitor

Short-term treatment (7 to 10 days) of patients with gastroesophageal reflux

Pantoprazole is usually given as an injection

Possible side effects of Pantoprazole :

Diarrhea; headache; nausea; stomach pain; vomiting.