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Cardiogenic shock
| Cardiogenic shock | |
|---|---|
| Ultrasound image after cardiogenic shock due to myocarditis[1] | |
| Specialty | Cardiology |
| Symptoms | Fatigue, rapid heartbeat, shortness of breath, hypotension, sweating, chest pain, dizziness or lightheadedness, nausea, decreased level of consciousness[2] |
| Complications | Worsening of or causing heart failure and/or heart block, serious arrhythmias such as ventricular fibrillation, cor pulmonale, respiratory or kidney or liver dysfunction or failure, multiple organ dysfunction syndrome, cardiac arrest, death |
| Causes | Heart attack, myocarditis, endocarditis, certain medications and substances[2] |
| Risk factors | Heart failure, old age, hypertension[2] |
| Prognosis | For patients where the cause is not due to a heart attack, the mortality rate is still relatively high, at about 60%; some progress has been made in treating cardiogenic shock when due to a heart attack, and the mortality rate is now somewhat lower for those with MI who survive and are treated rapidly with current therapies (February 2021)[3] |
Cardiogenic shock is a medical emergency resulting from inadequate blood flow to the body's organs due to the dysfunction of the heart. Signs of inadequate blood flow include low urine production (<30 mL/hour), cool arms and legs, and decreased level of consciousness. People may also have a severely low blood pressure and heart rate.
Causes of cardiogenic shock include cardiomyopathic, arrhythmic, and mechanical. Cardiogenic shock is most commonly precipitated by a heart attack.[4]
Treatment of cardiogenic shock depends on the cause with the initial goals to improve blood flow to the body. If cardiogenic shock is due to a heart attack, attempts to open the heart's arteries may help. Certain medications, such as dobutamine and milrinone, improve the heart's ability to contract and can also be used. When these measures fail, more advanced options such as mechanical support devices or heart transplantation can be pursued.
Cardiogenic shock is a condition that is difficult to fully reverse even with an early diagnosis.[4] However, early initiation of treatment may improve outcomes. Care should also be directed to any other organs that are affected by this lack of blood flow (e.g., dialysis for the kidneys, mechanical ventilation for lung dysfunction).
Mortality rates for cardiogenic shock are high but have been decreasing in the United States. This is likely due to its rapid identification and treatment in recent decades. Some studies have suggested that this is possibly related to new treatment advances. Nonetheless, the mortality rates remain high and multi-organ failure in addition to cardiogenic shock is associated with higher rates of mortality.[5]
- ^ "UOTW #7 – Ultrasound of the Week". Ultrasound of the Week. 30 June 2014. Retrieved 27 May 2017.
- ^ a b c "Cardiogenic shock – Symptoms and causes". Mayo Clinic. Retrieved 22 May 2020.
- ^ Schrage B, Becher PM, Goßling A, Savarese G, Dabboura S, Yan I, et al. (April 2021). "Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock". ESC Heart Failure. 8 (2): 1295–1303. doi:10.1002/ehf2.13202. PMC 8006704. PMID 33605565.
- ^ a b Vahdatpour C, Collins D, Goldberg S (April 2019). "Cardiogenic Shock". Journal of the American Heart Association. 8 (8): e011991. doi:10.1161/JAHA.119.011991. PMC 6507212. PMID 30947630.
- ^ Thiele H, de Waha-Thiele S, Freund A, Zeymer U, Desch S, Fitzgerald S (August 2021). "Management of cardiogenic shock". EuroIntervention. 17 (6): 451–465. doi:10.4244/EIJ-D-20-01296. PMC 9724885. PMID 34413010.
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