CARDIOGENIC SHOCK

INTRODUCTION: Cardiogenic shock occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and tissues. The causes of cardiogenic shock are known as either coronary or non-coronary. Coronary cardiogenic shock is more common than non-coronary cardiogenic shock and is seen most often in patients with acute myocardial infarction. Non-coronary causes of cardiogenic shock are related to conditions that stress the myocardium (eg, severe hypoxemia, acidosis, hypoglycemia, hypocalcemia, and tension pneumothorax) and conditions that result in ineffective myocardial function (eg, cardiomyopathies, valvular damage, cardiac tamponade, dysrhythmias).

CLINICAL MANIFESTATIONS: Classic signs include low blood pressure (BP), rapid and weak pulse. Dysrhythmias are common. Angina pain may be experienced. Hemodynamic instability. Complaints of fatigue.

MEDICAL MANAGEMENT: Goals of medical treatment include limiting further myocardial damage, preserving the healthy myocardium, and improving cardiac function. It is necessary first to treat the oxygenation needs of the heart muscle, increasing oxygen supply to the heart muscle while reducing oxygen demands. First-line treatment includes administering supplemental oxygen, controlling chest pain, administering fluids, and administering vasoactive medications (eg, dobutamine, nitroglycerin, dopamine) and antiarrhythmic medications. Hemodynamic monitoring and laboratory marker monitoring are performed. 

Mechanical cardiac support may be necessary. Coronary cardiogenic shock may be treated with thrombolytic therapy, a percutaneous coronary intervention, coronary artery bypass graft surgery, and/or intra-aortic balloon pump therapy. Noncoronary cardiogenic shock may be treated with cardiac valve replacement, correction of dysrhythmia, correction of acidosis and electrolyte disturbances, or treatment of the tension pneumothorax.

RELATED;

1. OTHER TYPES OF SHOCK  

2.  HYPERTENTION.  

3.  CONGESTIVE CARDIAC FAILURE

4.  MEDICAL CONDITIONS

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