Cardiogenic Shock

Cardiogenic shock is a disease state where the heart is damaged enough that it is unable to supply sufficient blood to the body. Cardiogenic shock is characterized by a decreased pumping ability of the heart that causes a shocklike state (ie, global hypoperfusion). Cardiogenic shock occurs when the heart is unable to pump blood and maintain an adequate blood supply for other vital organs. Cardiogenic shock has a death rate of about 60% and is the major cause of death in patients hospitalized for a heart attack. It most commonly occurs in association with, and as a direct result of, acute myocardial infarction (AMI). These patients would generally have poor cardiac output. Clinically they will have tissue hypoxia resulting in oliguria, cyanosis, altered mentation, and cool extremities. Cardiogenic shock typically is triggered by a heart attack, and is definitely life-threatening. Even with treatment, it ends in death 65 to 80 percent of the time.

Cardiogenic shock occurs in 8.6% of patients with ST-segment elevation MI with 29% of those presenting to the hospital already in shock. Tests used in patients with cardiogenic shock include:

• Electrocardiogram
• Coronary angiography
• Echocardiogram
• Nuclear scans

Sign and Symptoms of Cardiogenic Shock

• Hypotension (low blood pressure)
• Cold, clammy skin
• Chest pain
• Nausea and vomiting
• Dyspnoea
• Profuse sweating
• Confusion/disorientation
• Palpitations
• Faintness/syncope
• Low urine output
• Confusion or changes in alertness or unresponsiveness

Causes of Cardiogenic Shock

• Myocardial Infarction (heart attack)
• Myocardial suppression due to bacteraemia/sepsis (although, strictly speaking, this would be defined as septic shock)
• Myocarditis -a condition in which the heart does not pump properly because the heart muscle is inflamed and diseased
• Valvular Heart Disease -damage to heart valves interrupts blood flow
• Cardiac Arrhythmias -severe irregular heart rhythms cause uncoordinated blood flow through the heart
• Obstruction -certain conditions apply pressure or compress the heart, not allowing it to function as a pump.

Diagnosis, Treatment, and Cure of Cardiogenic Shock

Cardiogenic shock is a medical emergency. Treatment requires hospitalization. The goal of treatment is to save the patient's life and treat the underlying cause of shock. The patient may require intraaortic balloon pump therapy, ventricular assistive device, or might ultimately require cardiac transplant.

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