Cardiogenic shock is a form of shock caused by a weakened pumping ability of the heart. It is an absolute emergency, often resulting in death from heart failure if not treated promptly. There are many causes of cardiogenic shock.
What is cardiogenic shock?
A state of shock can be diagnosed very quickly based on the symptoms. However, it is more difficult to determine what form of shock is present. See AbbreviationFinder for abbreviations related to Cardiogenic Shock.
Cardiogenic shock is caused by a pump failure of the heart. As part of this disease process, the heart is no longer able to ensure the required cardiac output (HMV). Cardiac output defines the volume of blood that the heart pumps through the body in one minute. It is the product of heart rate and stroke volume.
The heart rate in turn refers to the heartbeats per minute. Stroke volume is the amount of blood that is pumped into the circulatory system by a heartbeat. Cardiac output is normally around 4.5 to 5 liters per minute. With unusual loads, the HMV can increase fourfold. This can be caused by an increase in heart rate as well as an increase in stroke volume.
Cardiac output can drop drastically for a variety of reasons. These causes include structural changes in the heart, heart valve defects, cardiac arrhythmias, high blood pressure, heart attacks or stiffening of the heart walls. Cardiogenic shock is the most extreme form of reduced cardiac output. However, cardiogenic shock is only one form of shock.
In addition to cardiogenic shock, there is also volume depletion shock, septic shock and anaphylactic shock. However, every shock is a life-threatening condition that is associated with an insufficient supply of oxygen to the internal organs. Regardless of the cause, the course of a shock is always the same.
Causes
Cardiogenic shock is generally caused by cardiac output failure. The cause is usually a pre-existing heart condition. The volume of blood flowing through the body suddenly decreases. As a result, there is an insufficient supply of oxygen to the organs. Due to the lack of oxygen, anaerobic degradation processes take place to an increased extent.
This metabolic pathway does not require oxygen to break down nutrients and endogenous substances. As a result, complete degradation does not take place. Among other things, acidic degradation products are formed. The body therefore becomes more and more acidic and thus fires the process even further. This acidosis relaxes the arterioles and damages the blood capillaries. A loss of fluid sets in, which in turn increases hypovolemia.
In addition, blood congestion occurs in the capillaries, which can lead to microthrombi. Regardless of its cause, the entire process intensifies more and more in the form of a vicious circle and is therefore also referred to as a so-called shock spiral. Cardiogenic shock can be caused, among other things, by a heart attack, general heart failure, bradycardia.
An extreme increase in heart rate, ischemia, arterial hypertension or heart valve defects can be caused. However, heart medication such as beta blockers, cytostatics or antidepressants can also trigger cardiogenic shock.
Symptoms, Ailments & Signs
Common symptoms of shock include pallor and hypotension. In cardiogenic shock there are also shortness of breath, chest pain and congested veins in the neck. A severely reduced pulse rate (bradycardia), ventricular fibrillation or pulmonary edema can also occur. Difficult breathing takes place with moist rattling noises.
The systolic blood pressure is below 90 mmHg with a cardiac index below 1.8 l/min/m². Each square meter of body surface is traversed by a maximum of 1.8 liters of blood per minute. This can lead to multi-organ failure of the liver, kidneys, intestines and central nervous system. Consciousness fades. Without treatment, cardiogenic shock can be fatal.
Diagnosis & course of disease
A state of shock can be diagnosed very quickly based on the symptoms. However, it is more difficult to determine what form of shock is present. However, a known heart disease and the additional symptoms that occur, such as shortness of breath or pulmonary edema, will quickly lead the doctor to the suspected diagnosis of “cardiogenic shock”. In this way, after the emergency treatment of the shock, the actual treatment of the heart can begin immediately.
Complications
This shock is usually a medical emergency. If there is no immediate treatment, the patient can die. This shock usually causes severe shortness of breath. The patient’s resilience drops significantly and the affected person appears tired and exhausted.
A reduced heart rate can also occur and the person concerned can also lose consciousness completely. The quality of life is significantly restricted and reduced by this shock. The internal organs also often no longer function properly, so that in the worst case this can lead to organ failure. It is not uncommon for patients to suffer from fear of death, panic attacks or sweating.
Treatment for this shock must be immediate for the patient to survive. Surgical interventions and medication are necessary to combat the symptoms. Furthermore, however, a causal treatment of this complaint is necessary so that the underlying disease is limited and shock does not occur again. Life expectancy may be reduced as a result. Further complications depend heavily on the underlying disease, so that it is usually not possible to make a general prediction.
When should you go to the doctor?
If symptoms such as shortness of breath, problems with the cardiovascular system or chest pain are noticed, a doctor should always be consulted. If the symptoms appear suddenly, an ambulance must be called. Cardiogenic shock can be fatal if not treated in time. Therefore, a doctor must be consulted at the first sign. If signs of a shock reaction are noticed, medical advice is also needed.
The first responders should call in the emergency services and, if in doubt, provide first aid measures. Typical shock symptoms such as shortness of breath or circulatory problems should always be clarified by a doctor, regardless of whether cardiogenic shock is suspected. In addition to the family doctor, the internist or a cardiologist can be involved. It may also be useful to involve a therapist, especially if the cardiogenic shock occurred in connection with an accident or a fall. Children showing signs of cardiogenic shock should be taken to the pediatrician promptly.
Treatment & Therapy
Cardiogenic shock is an emergency and needs to be treated as soon as possible. This includes a percutaneous coronary intervention (PCI). Here narrow passages are widened with a left heart catheter. For this purpose, a balloon or a stent is introduced via a catheter. In the presence of blood clots, systemic fibrinolysis is performed.
Fibrinolysis is an enzymatic cleavage of fibrin, which allows the thrombi to be dissolved. Furthermore, emergency bypass operations often have to be performed. At the same time, anticoagulant substances are administered to prevent the further formation of blood clots.
Anticoagulant substances include thrombocyte function inhibitors or thrombin inhibitors. Parallel to the emergency treatment, the cardiovascular system must be stabilized. The patient should be placed in a cardiac bed position. In cardiac bed positioning, the upper body is positioned high and the legs low. This is intended to reduce the venous blood flow to the heart.
The patient must be secured against slipping in this position. The circulatory system is additionally stabilized by vasoactive substances such as dobutamine, vasodilators or noradrenaline. Intra-aortic balloon counterpulsation is often performed as well. This is a balloon pump frequently used in emergency medicine, which improves the supply of oxygen by improving blood circulation.
Outlook & Forecast
Treatment with catheter intervention and the immediate opening of the blocked coronary arteries has significantly reduced the acute mortality rate of patients with cardiogenic shock over the past 20 years. Early detection of cardiogenic shock is crucial to reducing acute mortality.
If the cardiogenic shock remains untreated, this leads to multiple organ failure and consequently to the death of the patient. For the further prognosis of surviving patients of cardiogenic shock, the first time immediately after discharge from hospital seems to be particularly critical. Significantly more patients with cardiogenic shock die within the first 60 days than patients without shock. During the stay in the hospital, however, the chances of survival have increased significantly in recent years. In the 1980s, around 70 percent of all patients admitted to a clinic with cardiac shock died. Today it is about 40 percent.
Adequate therapy management and close cardiological controls can improve the short- and long-term prognosis of patients with cardiogenic shock. However, a complete recovery after an extended heart attack is usually no longer to be expected.
Prevention
The best way to prevent cardiogenic shock is to prevent atherosclerosis, which can lead to heart disease. This can be achieved through a healthy lifestyle with a balanced diet, plenty of exercise and by not drinking alcohol or smoking.
Aftercare
In the event of such a shock, the affected person usually only has a few follow-up measures available. An ambulance should be called quickly or a hospital should be visited directly so that the person concerned does not die as a result of this shock. In addition, the underlying disease must be treated to prevent this condition from recurring.
In many cases, however, such a shock significantly reduces the life expectancy of the person affected. In general, with this disease, the patient should rest and rest. You should refrain from exertion or from stressful or physical activities in order not to unnecessarily burden the body. Furthermore, a healthy lifestyle with a healthy diet and light sporting activities can have a positive effect on the course of the disease.
After emergency treatment, the cause of the shock must first be identified. Furthermore, the underlying disease must be limited, so that no general prediction can be made. The person affected should have their heart checked and checked regularly by a doctor. Further aftercare measures are usually not available to the person concerned. In many cases, they are strongly dependent on the underlying disease.
You can do that yourself
If cardiogenic shock occurs, first aid must be administered immediately. First responders should position the victim’s upper body slightly elevated. If you have low blood pressure, lying on your back is recommended, otherwise too much blood will flow into the upper body and the pump muscle, which has already been damaged, will be put under too much strain. If the patient is conscious, they should sit on the floor with their legs outstretched and support their upper body backwards with their arms. It should be noted that the affected person is not allowed to drink anything. His clothes are best loosened.
In addition to these measures, the emergency services must be called as soon as possible. If unconscious, chest compressions or rescue breaths are indicated. After the treatment, the patient must rest for at least three to four weeks. A lifestyle change may also be necessary. Depending on the cause, the doctor will recommend things like eating healthier, exercising more, and avoiding stress. It is important to avoid stimulants for the first time after the treatment. In order to avoid another shock, the clinic should be visited regularly for check-ups.
