| Cardiogenic shock | |
|---|---|
| Ultrasound showing cardiogenic shock due to myocarditis[1] | |
| Specialty | Cardiology |
| Symptoms | Altered mental status, clammy, bluish, or mottled skin.[2] |
| Complications | Kidney failure, respiratory failure, stroke[2] |
| Causes | Heart attack, valvular heart disease, aortic dissection, cardiomyopathy, myocarditis, arrhythmia, beta blocker or calcium channel blocker overdose[2] |
| Risk factors | Diabetes, old age, females[2] |
| Diagnostic method | SBP < 90 mmHg, urine output < 30 mL/hr, cool extremities[2] |
| Differential diagnosis | Septic shock, neurogenic shock, hemorrhagic shock, obstructive shock[2][3] |
| Treatment | Raise blood pressure, support breathing, reverse any underlying causes[2] |
| Deaths | 30 to 80% risk[2] |
Cardiogenic shock (CS) is a disorder of the heart that results in prolonged inadequate blood flow to the tissues of the body.[2] The most common symptoms are altered mental status and clammy, bluish, or mottled skin.[2] Swelling may be present in the legs.[2] Complications may include kidney failure, respiratory failure, and stroke.[2]
The most common cause is a heart attack.[2] Other causes include valvular heart disease, aortic dissection, cardiomyopathy, myocarditis, arrhythmia, and beta blocker or calcium channel blocker overdose.[2] Diagnosis involves a systolic blood pressure less than 90 mmHg and a urine output of less than 30 mL/hr or cool arms and legs.[2] This occurs despite sufficient volume in the blood vessels.[4] Cardiac tamponade and pulmonary embolism are generally deemed to be causes of obstructive shock.[3]
The initial goal of treatment is to raise the blood pressure, support breathing, and reverse any underlying causes.[2] This may include intravenous fluids and vasopressors such as norepinephrine or dobutamine.[2] A central line and arterial line may be useful for giving medications and monitoring the condition.[2] If the underlying cause is a heart attack, primary percutaneous coronary intervention (PCI) is recommended.[2] Other efforts may include extracorporeal membrane oxygenation (ECMO), ventricular assist device (VAD), or heart transplant.[2] Mechanical ventilation or dialysis may also be required.[5] Palliative care may be useful in certain cases.[2]
Cardiogenic shock affects about 7% of STEMIs and 3% of NSTEMIs.[2] It is becoming less common with the greater use of primary percutaneous coronary intervention (PCI) for heart attacks.[2] Poor outcomes are common, with a 30% to 80% risk of death.[2] The condition was first described in 1912 by Herrick; however, the current name for the condition did not come into use until 1942.[4]
References edit
- ^ "UOTW #7 - Ultrasound of the Week". Ultrasound of the Week. 30 June 2014. Retrieved 27 May 2017.
- ^ a b c d e f g h i j k l m n o p q r s t u v w x Kosaraju, A; Pendela, VS; Hai, O (January 2020). "Cardiogenic Shock". PMID 29489148.
{{cite journal}}: Cite journal requires|journal=(help) - ^ a b "Shock - Critical Care Medicine". Merck Manuals Professional Edition. Retrieved 31 December 2020.
- ^ a b Hochman, Judith S.; MD, E. Magnus Ohman (2009). Cardiogenic Shock. John Wiley & Sons. p. 1. ISBN 978-1-4443-1693-3.
- ^ Simko, Lynn Coletta; Culleiton, Alicia L. (July 2019). "Cardiogenic shock with resultant multiple organ dysfunction syndrome". Nursing Critical Care. 14 (4): 26–33. doi:10.1097/01.CCN.0000565132.49413.54.