Cardiogenic shock is an acute ventricular failure with a sharp decrease in the contractile function of the heart and, as a consequence, a decrease in blood pressure and insufficient blood supply to the organs. Most often, cardiogenic shock develops as a complication of myocardial infarction and in most cases leads to death.
Causes of cardiogenic shock
Among the provoking factors distinguish:
- an extensive myocardial infarction , in which more than 40% of the myocardium is affected, and the heart can not normally contract and pump blood;
- inflammation of the heart muscle (acute myocarditis);
- the rupture of the interventricular septum separating the right ventricle of the heart from the left;
- acute stenosis (constriction) of the heart valves;
- acute failure of the heart valves;
- massive thromboembolism of the pulmonary artery.
Types of cardiogenic shock
In medicine, it is customary to distinguish three forms of cardiogenic shock: reflex, true cardiogenic shock and arrhythmic:
- Reflex. It is the lightest form, which, as a rule, is caused not by extensive damage to the myocardium, but by a decrease in blood pressure due to severe pain syndrome. With the timely relief of pain, further prognosis is relatively favorable.
- A true cardiogenic shock. It occurs with extensive heart attacks. In the event that 40% or more of the heart is necrotic, the mortality rate is close to 100%.
- Arrhythmic shock. It develops due to a sharp ventricular tachycardia or acute bradyarrhythmia. Disorders of blood supply are associated with a change in the frequency of heart contractions and after the normalization of its rhythm, the symptoms of shock usually go away.
Clinical symptoms and diagnosis of cardiogenic shock
Among them are:
- a sharp decrease in blood pressure (less than 90 mm Hg) and pulsed (less than 20 mm Hg) pressure;
- tachycardia;
- Pale (often with cyanotic elements) and moist skin;
- cold extremities;
- decreased veins due to pressure decrease;
- loss of consciousness;
- violation of urination (at an arterial pressure below 50 mm Hg, the kidneys stop working).
If the patient has symptoms of cardiogenic shock, doctors assess the severity of these symptoms, measure arterial and pulse pressure, heart rate, and assess the cardiac index. The following procedures are also used to establish the exact cause and the affected area:
- Electrocardiogram - to determine the stage and location of the infarct, its depth and vastness.
- Ultrasound of the heart - helps to assess the extent of damage, to determine the amount of blood ejected by the heart in the aorta, to determine which of the heart departments suffered.
- Angiography is an x-ray contrast method of examining vessels, in which a contrast agent is injected into the femoral artery. This examination is carried out if surgical methods of treatment are possible.
Treatment of cardiogenic shock
Treatment of this disease is carried out exclusively in the intensive care unit of the hospital. Emergency measures for cardiogenic shock are aimed at increasing blood pressure and normalizing the blood supply of vital organs.
General measures:
- Anesthesia. It is especially important in the reflex form of shock.
- Oxygenotherapy. Use of an oxygen mask to prevent oxygen starvation of the brain.
- Thrombolytic therapy. Intravenous administration of drugs to improve blood circulation and prevent the formation of blood clots.
- Supportive therapy. Intravenous administration of drugs with potassium and magnesium to improve the nutrition of the heart muscle.
Stimulation. The introduction of drugs that stimulate the reduction of the heart muscle.
Treatment of cardiogenic shock is necessarily accompanied by monitoring the activities of vital organs:
- The cardiac monitor.
- Regular measurement of pressure and heart rate.
- Installing a urinary catheter to assess kidney function.
After taking primary measures, further treatment is determined depending on the type and severity of the patient's condition, and it can be both surgical and conservative.