Cardiogenic shock is left ventricular heart failure in the acute stage. It develops in a few hours at the appearance of the first signs of myocardial infarction, less often - in a later period. Reduction of the level of minute and shock volume of blood can not even be compensated by the growth of vascular resistance. As a result, blood pressure decreases and blood circulation in vital organs is disturbed.
Features of the ailment
Cardiogenic shock occurs as a result of a violation of oxygen supply to the organs. With a decrease in cardiac output, there is a decrease in perfusion to all organs. Shock causes microcirculation disorder, microthrombi are formed. The work of the brain is broken, acute kidney and liver failure develops, trophic ulcers can form in digestive organs, due to deterioration of blood supply in the lungs, metabolic acidosis develops.
- In adults, the body compensates for this condition by reducing systemic vascular resistance, increasing the frequency of heart contraction.
- In children, this condition is compensated by increased heart rate and blood vessel compression( vasoconstriction).The latter causes the fact that hypotension is a late sign of shock.
Classification of cardiogenic shock is discussed further.
On the pathogenesis and features of cardiogenic shock tells the following video:
There are 3 types( forms) of cardiogenic shock:
- is true.
Arrhythmic shock occurs due to paroxysm of tachycardia or acute bradyarrhythmia as a result of complete atrioventricular blockade. Violations of functions are due to changes in heart rate. After the heart rhythm is restored, the phenomena of shock disappear.
Reflex shock is the easiest form and is caused not by damage to the heart muscle, but by a decrease in blood pressure as a result of the pain syndrome after a heart attack. With timely treatment, the pressure comes back to normal. In the opposite case, a transition to a true cardiogenic one is possible.
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The opinion of doctors. .. & gt; & gt;
True cardiogenic develops with extensive myocardial infarction as a result of a sharp decrease in the functions of the left ventricle. With necrosis of 40% or more, there is development of an ariatic cardiogenic shock. Sympathomimetic amines do not help. The lethality is 100%.
For the criteria and causes of cardiogenic shock, see below.
Cardiogenic shock develops due to myocardial infarction, as its complication. Less often it can arise as a complication after myocarditis and poisoning with cardiotoxic substances.
Immediate causes of the disease:
- severe arrhythmias;
- disruption of the pumping function of the heart;
- ventricular tamponade as a result of effusion or intracardiac bleeding;
- pulmonary embolism.
As a result of exclusion of some part of the myocardium, the heart can not fully provide blood supply to the body and brain, including. Plus, the affected area of the heart with coronary artery thrombosis increases due to reflex spasms of nearby arterial vessels.
As a result, develops ischemia and acidosis, which leads to more severe processes in the myocardium. Often the process is aggravated by ventricular fibrillation, asystole, respiratory arrest and death of the patient.
Next, let's talk about the clinical symptoms of cardiogenic shock.
For cardiogenic shock is characterized by:
- a sharp pain in the chest, giving off in the upper limbs, scapula and neck;
- feeling of fear;
- increased heart rate;
- a systolic pressure drop of up to 70 mm Hg;
- is an earthy complexion.
If you do not provide timely assistance, the patient may die.
Clinical manifestations of cardiogenic shock:
- pallor of the skin, cyanosis;
- low body temperature;
- sticky sweat;
- superficial breathing with difficulty;
- frequent pulse;
- deaf heart sounds;
- decreased diuresis or anuria;
- pain in the heart.
The following additional examination methods are performed:
- electrocardiogram for the purpose of studying focal changes in the myocardium;
- echocardiogram for evaluation of contractile features;
- angiography for the analysis of vascular status.
Treatment of cardiogenic shock in myocardial infarction is discussed below.
Cardiogenic shock is a condition in which you should call an ambulance as soon as possible. And even better - a specialized resuscitation cardiological team.
For the algorithm of action for emergency care for cardiogenic shock, read below.
Emergency care for
First emergency care for cardiogenic shock should be carried out immediately in the following order:
- put the patient and lift his legs;
- provide air access;
- do artificial respiration if there is none;
- to introduce thrombolytics, prednisolone, anticoagulants;
- in the absence of cardiac contractions to perform defibrillation;
- perform an indirect heart massage.
For preparations with cardiogenic shock, read on.
The following video is dedicated to the treatment of cardiogenic shock:
The goal of the treatment: to eliminate pain, increase blood pressure, normalize the heart rate, prevent the expansion of ischemic damage to the heart muscle.
- Apply analgesics of a narcotic nature. It is necessary to begin to drip intravenously a solution of glucose, and to increase pressure - vasoprescessor drugs dosed( noradrenaline or dopamine), hormonal drugs.
- Once the pressure returns to normal, the patient should be given drugs to expand the coronary vessels and improve microcirculation. This is sodium nitrosorbide or nitroglycerin. Heparin and bicarbonate are shown.
- If the heart stopped, spend indirect massage, ventilator, re-enter norepinephrine, lidocaine, gibrocarbonate. If necessary, defibrillation is performed.
It is very important to try to take the patient to the hospital. In modern centers, the latest methods of rescue are used, such as counterpulsation. A catheter with a balloon at the end is inserted into the aorta. When diastole the balloon straightens, with systole - falls. This ensures the filling of blood vessels.
Surgical intervention is an extreme measure. This percutaneous transluminal coronary angioplasty.
The procedure allows restoring the patency of arteries, retaining the myocardium, interrupting the vicious circle of the appearance of cardiogenic shock. To conduct such an operation should be no later than 6-8 hours after the onset of a heart attack.
To preventive measures to avoid the development of cardiogenic shock, include:
- sport in a moderate amount;
- smoking cessation;
- high-grade and proper nutrition;
- a healthy lifestyle;
- Avoiding stress.
Complications of cardiogenic shock
With cardiogenic shock, there is a violation of blood circulation of all organs of the body. There may be signs of hepatic and renal insufficiency, trophic ulcers of the digestive organs, thromboses of the brain.
The pulmonary blood flow decreases, which leads to oxygen hypoxia and increased acidity of the blood.
Mortality in cardiogenic shock is 85-90%.Only a few reach the hospital and successfully recover.
Even more useful information on cardiogenic shock is contained in the following video: