Cardiogenic shock 1301620 221802126 2008-06-26T04:33:17Z Filip em 7200976 change interwiki {{Infobox_Disease | Name = {{PAGENAME}} | Image = | Caption = | DiseasesDB = 29216 | ICD10 = {{ICD10|R|57|0|r|50}} | ICD9 = {{ICD9|785.51}} | ICDO = | OMIM = | MedlinePlus = 000185 | eMedicineSubj = med | eMedicineTopic = 285 | MeshID = D012770 | }} '''Cardiogenic shock''' is based upon an inadequate circulation of [[blood]] due to primary failure of the [[ventricle (heart)|ventricle]]s of the [[heart]] to function effectively.<ref name="IrwinRippe"> [http://www.lww.com/product/?0-7817-3548-3 Irwin and Rippe's Intensive Care Medicine] by Irwin and Rippe, Fifth Edition (2003), [[Lippincott Williams & Wilkins]], ISBN 0-7817-3548-3</ref> <ref name="Marino"> [http://www.lww.com/product/?0-683-05565-8 The ICU Book] by Paul Marino MD, PhD, Second Edition (1997), [[Lippincott Williams & Wilkins]], ISBN 0-683-05565-8 </ref> <ref name="FCCS"> [http://www.sccm.org/education/fccs_courses/course_textbook/index.asp Fundamental Critical Care Support, A standardized curriculum of Critical Care] by the [[Society of Critical Care Medicine]]</ref> <ref name="InternalMedicine"> Textbooks of Internal Medicine * [http://books.mcgraw-hill.com/medical/harrisons/ Harrison's Principles of Internal Medicine] 16th Edition, The [[McGraw-Hill]] Companies, ISBN 0-07-140235-7 * [http://www.cecilmedicine.com/buy.cfm?book=goldman Cecil Textbook of Medicine] by Lee Goldman, Dennis Ausiello, 22nd Edition (2003), W.B. Saunders Company, ISBN 0-7216-9652-X * [http://www.oup.com/us/catalog/general/subject/Medicine/PrimaryCare/?ci=0192629220&view=usa The Oxford Textbook of Medicine] Edited by David A. Warrell, Timothy M. Cox and John D. Firth with Edward J. Benz, Fourth Edition (2003), [[Oxford University Press]], ISBN 0-19-262922-0</ref> <ref name="Overview"> [http://www.surgicalcriticalcare.net/Lectures/shock_overview.pdf Shock: An Overview] [[PDF]] by Michael L. Cheatham, MD, Ernest F.J. Block, MD, Howard G. Smith, MD, John T. Promes, MD, Surgical Critical Care Service, Department of Surgical Education, [[Orlando Regional Medical Center]] [[Orlando, Florida|Orlando]], Florida</ref> Since this is a category of [[Shock (medical)|shock]] there is insufficient [[perfusion]] of [[Biological tissue|tissue]] (i.e. the [[heart]]) to meet the required demand for [[oxygen]] and [[nutrients]]. This leads to [[cell (biology)|cell]] death from [[oxygen]] starvation, [[hypoxia (medical)|hypoxia]]. Because of this it may lead to [[cardiac arrest]] (or circulatory arrest) which is an acute cessation of cardiac pump function.<ref name="InternalMedicine"/> Cardiogenic shock is defined by sustained hypotension with tissue hypoperfusion despite adequate left ventricular filling pressure. Signs of tissue hypoperfusion include oliguria (<30 mL/h), cool extremities, and altered mentation. == Etiology == Cardiogenic shock is caused by the failure of the heart to pump effectively. It can be due to damage to the [[heart]] muscle, most often from a large [[myocardial infarction]]. Other causes include [[cardiac arrhythmia|arrhythmia]], [[cardiomyopathy]], [[cardiac valve]] problems, ventricular outflow obstruction (i.e. [[aortic valve stenosis]], [[aortic dissection]], systolic anterior motion (SAM) in [[hypertrophic cardiomyopathy]]), ventriculoseptal defects or medical error. <ref name="IrwinRippe"/> <ref name="Marino"/> <ref name="InternalMedicine"/> <ref name="FCCS"/> <ref name="Overview"/> <ref name="HongKongCS"> [http://www.aic.cuhk.edu.hk/web8/cardiogenic_shock.htm Cardiogenic shock] Department of Anaesthesia and Intensive Care of The Chinese University of [[Hong Kong]]</ref> <ref name="HongKong"> [http://www.aic.cuhk.edu.hk/web8/shock.htm Introduction to management of shock for junior ICU trainees and medical students] Department of Anaesthesia and Intensive Care of The Chinese University of [[Hong Kong]]</ref> == Signs and symptoms == * Anxiety, restlessness, [[Glasgow Coma Scale|altered mental state]] due to decreased cerebral perfusion and subsequent [[hypoxia (medical)|hypoxia]]. * Hypotension due to decrease in [[cardiac output]]. * A rapid, weak, thready pulse due to decreased circulation combined with tachycardia. * Cool, clammy, and mottled skin ([[cutis marmorata]]), due to vasoconstriction and subsequent hypoperfusion of the skin. * Distended [[jugular vein]]s due to increased jugular venous pressure. * Oliguria (low urine output) due insufficient renal perfusion if condition persists. * Rapid and deep respirations (hyperventilation) due to sympathetic nervous system stimulation and acidosis. * Fatigue due to hyperventilation and hypoxia. * Absent pulse in tachy[[arrhythmia]]. * [[Pulmonary edema]], involving fluid back-up in the lungs due to insufficient pumping of the heart. == Diagnosis == === Electrocardiogram === An [[ECG|electrocardiogram]] helps establishing the exact diagnosis and guides treatment, it may reveal: * [[Cardiac arrhythmia]]s * Signs of [[cardiomyopathy]] === Radiology === [[Echocardiography]] may show arrhythmia, signs of PED, [[ventricular septal rupture]] (VSR), an obstructed outflow tract or cardiomyopathy. === Swan-ganz catheter === The [[Swan-ganz catheter]] or Pulmonary artery catheter may assist in the diagnosis by providing information on the hemodynamics. === Biopsy === In case of suspected cardiomyopathy a [[biopsy]] of heart muscle may be needed to make a definite [[diagnosis]]. == Treatment == In cardiogenic shock: depending on the type of myocardal infarction one can infuse fluids or in shock refractory to infusing fluids [[Inotrope|inotropica]]. In case of [[cardiac arrhythmia]] several anti-arrhythmic agents may be administered, i.e. [[adenosine]], [[verapamil]], [[amiodarone]], [[Beta blocker|β-blocker]]. Positive [[inotrope|inotropic agents]], which enhance the heart's pumping capabilities, are used to improve the contractility and correct the hypotension. Should that not suffice an [[intra-aortic balloon pump]] (which reduces [[afterload|workload]] for the heart, and improves perfusion of the [[coronary arteries]]) can be considered or a left [[ventricular assist device]] (which augments the pump-function of the heart). <ref name="IrwinRippe"/> <ref name="Marino"/> <ref name="FCCS"/> Cardiogenic shock may be treated with intravenous [[dobutamine]], which acts on β<sub>1</sub> receptors of the heart which causes increased power and heart rate. <ref>Rang and Dale's Pharmacology, H.P. Rang, M.M. Dale, J.M.Ritter, R.J. Flower, Churchhill Livingston, Elsevier, 6th Edition</ref> ==Notes== <references/> == References == *Irwin, R.S., Rippe, J.M., Curley, F.J., Heard, S.O. (1997) Procedures and Techniques in Intensive Care Medicine (3rd edition). Boston: Lippincott, Williams and Wilkins. *Marino, P. (1997) The ICU Book. (2nd edition). Philadelphia: Lippincott, Williams and Wilkins. == External links == * [http://www.emedicine.com/med/topic285.htm Cardiogenic Shock] by [[eMedicine]] {{General symptoms and signs}} [[Category:Cardiology]] [[Category:Cardiovascular diseases]] [[Category:medical emergencies]] [[Category:Intensive care medicine]] [[de:Kreislaufstillstand]] [[es:Parada cardiorrespiratoria]] [[fr:Arrêt cardio-circulatoire]] [[id:Gagal jantung]] [[he:דום לב]] [[nl:Hartstilstand]] [[ja:心停止]] [[pl:Wstrząs kardiogenny]] [[pt:Choque cardiogênico]] [[sr:Кардиогени шок]]