There can be no cardiogenic shock. Causes, symptoms and emergency care for cardiogenic shock

01.04.2020

It is a true cardiogenic shock, which is the cause of death in 90% of cases. The pathological process is based on an acute and sudden cessation of blood flow in most organs and tissues of the body, which leads to irreversible changes in cellular structures.

Vascular collapse may occur in the background different types acute conditions (with bleeding, against the background of sepsis, with thromboembolism): cardiogenic shock - acute cardiac pathology, most often arising from infarction of the left ventricle.

Acute coronary syndrome (ACS) has typical clinical manifestations, first aid for cardiogenic shock involves intensive resuscitation measures, and the consequences depend on the degree of damage to the vital important organs and body systems.

Shock heart options

Shock is a typical syndrome characteristic of a large number of dangerous pathological conditions and requires emergency medical care... Cardiogenic shock, the classification of which distinguishes several types of acute situations, occurs in cardiac pathology. The following forms of cardiogenic shock are possible:

true (cardiogenic shock with myocardial infarction);
CS in the background;
reflex;
areactive cardiogenic shock.

Big predictive value for survival has the severity of the impaired coronary circulation:

medium;
heavy;
are reactive.

Cardiogenic shock of any stage is characterized by a sudden and pronounced decrease in blood pressure and cessation of blood flow, which is manifested by many symptoms and signs that indicate a life-threatening pathology.

Causal factors of the acute condition

Any types and variants of cardiogenic shock occur when the main function of the heart is disturbed: the cessation of the pump operation leads to the absence of oxygenated blood in the vessels. All causes of cardiogenic shock can be divided into 2 groups:

Systolic dysfunction of the heart

The most common causative factor is myocardial infarction. In addition, the following pathological options are possible:

severe myocarditis;
heart surgery;
rupture of the heart muscle;
toxic effects medicines or alcoholic beverages.

Acute mechanical overload of the left ventricle

Cessation of blood flow into the aorta may occur against the background of the following factors:

acute cardiac insufficiency at the level of the mitral or aortic valve;
infective endocarditis;
surgical intervention;
, because of which cardiogenic shock most often occurs in children;
interventricular defect;
acute aneurysm in the wall of the left ventricle;
spherical thrombus in the atrium;
acute arrhythmia with the original violation coronary blood flow.

Whatever the causative factor, it is important to understand how cardiogenic shock develops and progresses: the pathogenesis of a life-threatening condition determines the symptoms of the disease and indicates the outcome of coronary pathology. Due to the complete or partial stopping of the pump in the chest, the cardiac output (the amount of blood sent to the tissues) sharply decreases, which leads to the formation of a vicious circle: the less blood is pumped, the worse the supply of vital organs and the less the supply of the heart muscle. The state of shock becomes irreversible when total ischemia of the cellular structures of the heart, brain and the most important internal organs.

Symptoms and signs of coronary heart disease

For quick diagnosis and effective primary care, you need to know the criteria for cardiogenic shock:

sudden and catastrophic drop in systolic blood pressure below 80-60 mm Hg. Art .;
a fast heart rate that is very difficult to detect on the wrist;
frequent and shallow breathing;
a change in consciousness up to a coma;
sharp pallor skin;
significant decrease or absence of urine.

It is not always that extensive vascular collapse develops immediately and with lightning speed. It is desirable to detect signs of cardiogenic shock before the onset of irreversible symptoms, which is especially important in myocardial ischemia. Most often the following manifestations dangerous pathology:

burning increasing pain in the chest region;
irritability, psycho-emotional excitement with a feeling of fear;
cutaneous cyanosis, pallor, and severe sweating;
apathy and severe weakness associated with a fall in blood pressure;
, and rapid breathing.

Cardiogenic shock, the symptoms of which indicate a severe and areactive stage of the disease, is almost impossible to cure, therefore, timely diagnosis of the initial forms of an acute pathological condition and detection medium the severity of coronary disorders is the only chance to save a person's life.

Emergency help

Effective treatment of cardiogenic shock depends on the severity of the acute coronary syndrome and the speed of delivery of the sick person to the cardiac intensive care unit of a specialized hospital. Of great importance for the forecast is urgent Care with cardiogenic shock, carried out by a resuscitation team doctor.

The specialist will perform the following mandatory tasks:

Providing effective pain relief;
Removal of emotional arousal;
Correction of respiratory disorders (oxygen mask, if necessary, providing artificial ventilation);
Drug therapy aimed at increasing blood pressure and preventing irreversible changes in organs and tissues of the body.

In addition to a dropper and constant measurement of vascular tone, the doctor will inject intravenous drugs to maintain work and ensure the correct heart rhythm, means to improve vascular blood flow and correct metabolic disorders.

The main task of an emergency resuscitation team doctor is to prevent irreversible circulatory disorders in vital organs and to deliver the patient to the cardiac intensive care unit as quickly as possible.

Complications and consequences

Discovered in time acute pathology and correctly provided emergency care for cardiogenic shock does not at all guarantee against the following frequently occurring types of complications:

respiratory failure (shock lung - shortness of breath, edema in lung tissue, pronounced metabolic and vascular disorders);
acute renal pathology (shock kidney - absence or extremely low amount of urine, necrotic damage in the tissues of the excretory system);
liver failure with the death of part of the liver cells;
the occurrence of acute ulcers and erosions in the stomach, which lead to bleeding;
the appearance in the vascular bed of small blood clots;
necrotic changes in soft tissues extremities (gangrene), arising from the lack of blood flow in the small vessels of the legs and arms.

The most dangerous complication in a sudden heart attack or in acute cardiac pathology with impaired general blood flow in the body is cardiogenic shock. The provision of emergency care in this condition should be as fast as possible, but even with timely admission to cardiac intensive care, the probability of survival is about 10%. Optimal prevention of an extremely dangerous complication and prevention of the disabling consequences of a shock state - regular examination by a doctor, therapy for heart disease and the implementation of the recommendations of a specialist in the prevention of myocardial infarction.

Cardiogenic shock is a life-threatening condition that develops as a result of a sharp violation of the contractile function of the left ventricle, a decrease in the cardiac output and stroke volume, as a result of which the blood supply to all organs and tissues of the body is significantly impaired.

Cardiogenic shock is not an independent disease, but develops as a complication of heart pathologies.

Causes

The cause of cardiogenic shock is impaired myocardial contractility (acute myocardial infarction, hemodynamically significant arrhythmias, dilated cardiomyopathy) or morphological disorders (acute valvular insufficiency, rupture of the interventricular septum, critical aortic stenosis, hypertrophic cardiomyopathy).

The pathological mechanism of the development of cardiogenic shock is complex. Violation of the contractile function of the myocardium is accompanied by a decrease in blood pressure and activation of the sympathetic nervous system... As a result, the contractile activity of the myocardium increases, and the rhythm becomes more frequent, which increases the heart's need for oxygen.

A sharp decline cardiac output causes a decrease in blood flow in the renal artery basin. This leads to fluid retention in the body. The increasing volume of circulating blood increases the preload on the heart and provokes the development of pulmonary edema.

Long-term inadequate blood supply to organs and tissues is accompanied by the accumulation of under-oxidized metabolic products in the body, as a result of which metabolic acidosis develops.

Mortality in cardiogenic shock is very high - 85-90%.

Views

According to the classification proposed by Academician E.I. Chazov, the following forms of cardiogenic shock are distinguished:

Reflex. It is caused by a sharp drop in vascular tone, which leads to a significant drop in blood pressure.
True. The main role belongs to a significant decrease in the pumping function of the heart with a slight increase in peripheral total resistance, which, however, is not enough to maintain an adequate level of blood supply.
Areactive. It occurs against the background of extensive myocardial infarction. The tone of the peripheral blood vessels, and microcirculation disorders are manifested with maximum severity.
Arrhythmic. Deterioration of hemodynamics develops as a result of a significant disturbance of the heart rhythm.

Signs

The main symptoms of cardiogenic shock:

a sharp decrease in blood pressure;
threadlike pulse (frequent, weak filling);
oligoanuria (decrease in the amount of urine excreted less than 20 ml / h);
lethargy, up to a coma;
pallor (sometimes marbling) of the skin, acrocyanosis;
decrease in skin temperature;
pulmonary edema.

Diagnostics

The diagnostic scheme for cardiogenic shock includes:

coronary angiography;
chest x-ray (concomitant pulmonary pathology, size of the mediastinum, heart);
electro- and echocardiography;
computed tomography;
a blood test for heart enzymes, including troponin and phosphokinase;
analysis of arterial blood for gas composition.

Cardiogenic shock is not an independent disease, but develops as a complication of heart pathologies.

Treatment

check the patency of the airways;
install a wide-diameter intravenous catheter;
connect the patient to a heart rate monitor;
deliver humidified oxygen through a face mask or nasal catheters.

After that, activities are carried out aimed at finding the cause of cardiogenic shock, maintaining blood pressure, cardiac output. Drug therapy includes:

analgesics (allow you to stop pain syndrome);
cardiac glycosides (increase contractile activity myocardium, increase the stroke volume of the heart);
vasopressors (increase coronary and cerebral blood flow);
phosphodiesterase inhibitors (increase cardiac output).

If indicated, other drugs are prescribed (glucocorticoids, volemic solutions, β-blockers, anticholinergics, antiarrhythmic drugs, thrombolytics).

Prevention

Prevention of the development of cardiogenic shock is one of the most important measures in the treatment of patients with acute cardiopathology, it consists in the rapid and complete relief of pain syndrome, restoration of the heart rhythm.

Potential consequences and complications

Cardiogenic shock is often accompanied by the development of complications:

sharp mechanical damage heart (rupture of the interventricular septum, rupture of the left ventricular wall, mitral insufficiency, cardiac tamponade);
severe left ventricular dysfunction;
right ventricular infarction;
violations of conduction and heart rhythm.

Mortality in cardiogenic shock is very high - 85-90%.

Cardiogenic shock is a pathological process when the contractile function of the left ventricle fails, the blood supply to tissues and internal organs deteriorates, which often ends in death.

It should be understood that cardiogenic shock is not an independent disease, but another disease, condition and other life-threatening pathological processes can be the cause of the anomaly.

The condition is extremely life-threatening: if the correct before medical assistance, there is a lethal outcome. Unfortunately, in some cases, even the provision of assistance by qualified doctors is not enough: statistics are such that biological death occurs in 90% of cases.

Complications that occur regardless of the stage of development of the condition can lead to serious consequences: the blood circulation of all organs and tissues is disrupted, the brain can develop, acute and, in the digestive organs, and so on.

According to international classification diseases of the tenth revision, the condition is in the section "Symptoms, signs and abnormalities that are not classified elsewhere." ICD-10 code - R57.0.

Etiology

In most cases, cardiogenic shock develops with myocardial infarction as a complication. But there are other etiological factors for the development of the anomaly. The causes of cardiogenic shock are as follows:

complication after;
poisoning with cardiac substances;
pulmonary artery;
intracardiac bleeding or effusion;
poor work of the pumping function of the heart;
heavy;
acute valvular insufficiency;
hypertrophic;
rupture of the interventricular septum;
traumatic or inflammatory damage to the pericardial bag.

Any condition is extremely life-threatening, therefore, if there is a diagnosis, you must carefully follow the doctor's recommendations, and if you feel unwell, urgently seek medical help.

Pathogenesis

The pathogenesis of cardiogenic shock is as follows:

as a result of certain etiological factors, a sharp decrease in cardiac output occurs;
the heart can no longer fully provide the blood supply to the body, including the brain;
acidosis also develops;
the pathological process may be aggravated by ventricular fibrillation;
asystole occurs, respiratory arrest;
if resuscitation measures do not give the desired result, the patient's death occurs.

The problem is developing very rapidly, so there is virtually no time for treatment.

Classification

Heart rate, blood pressure indicators, clinical signs, and duration of the abnormal state define three degrees of cardiogenic shock. There are several more clinical forms pathological process.

Types of cardiogenic shock:

reflex cardiogenic shock - easily arrested, characterized by severe pain;
arrhythmic shock - associated with or due to a small cardiac output;
true cardiogenic shock - such a cardiogenic shock is classified by the classification as the most dangerous (death occurs in almost 100%, because pathogenesis leads to irreversible changes that are incompatible with life);
areactive - according to the mechanism of development, it is actually an analogue of true cardiogenic shock, but pathogenetic factors are more pronounced;
cardiogenic shock due to myocardial rupture - a sharp drop in blood pressure, cardiac tamponade as a result of previous pathological processes.

Regardless of what form of the pathological process is available, the patient urgently needs to be provided with first aid for cardiogenic shock.

Symptoms

The clinical signs of cardiogenic shock are similar to those of a heart attack and similar pathological processes. The anomaly cannot be asymptomatic.

Symptoms of cardiogenic shock:

weak, threadlike pulse;
a sharp decrease in blood pressure indicators;
decrease in the daily amount of excreted urine - less than 20 ml / h;
lethargy of a person, in some cases occurs coma;
pallor of the skin, sometimes acrocyanosis occurs;
pulmonary edema with corresponding symptoms;
decrease in skin temperature;
shallow, wheezing breathing;
increased sweating, sticky sweat;
muffled heart sounds are heard;
sharp pain in the chest, which radiates to the area of \u200b\u200bthe shoulder blades, arms;
if the patient is conscious, there are panic fear, anxiety, possibly a state of delirium.

Lack of emergency care for symptoms of cardiogenic shock will inevitably lead to death.

Diagnostics

The symptoms of cardiogenic shock are pronounced, so there are no problems with the diagnosis. First of all, resuscitation measures are carried out in order to stabilize a person's condition, and only then diagnostics are carried out.

Diagnosis of cardiogenic shock includes the following procedures:

chest x-ray;
angiography;
echocardiography;
electrocardiography
biochemical analysis blood;
collection of arterial blood for gas analysis.

The diagnostic criteria for cardiogenic shock are taken into account:

heart sounds are muffled, a third tone can be detected;
kidney function - diuresis or anuria;
pulse - threadlike, small filling;
blood pressure indicators - reduced to a critical minimum;
breathing - shallow, labored, with high elevation of the chest;
pain - sharp, for the whole chest, gives to the back, neck and arms;
human consciousness - semi-delirium, loss of consciousness, coma.

Based on the results of diagnostic measures, the tactics of treating cardiogenic shock are selected - the selection of drugs is carried out and general recommendations are drawn up.

Treatment

It is possible to increase the chances of recovery only if first aid is provided to the patient in a timely manner and correctly. Along the way, with these activities, you should call the emergency medical team and clearly describe the symptoms.

They provide emergency care for cardiogenic shock according to the algorithm:

lay the person on a hard, flat surface and raise their legs;
unfasten the collar and the belt of the trousers;
provide access to fresh air, if this is a room;
if the patient is conscious, give a "Nitroglycerin" tablet;
if there are visible signs of cardiac arrest, start an indirect massage.

The ambulance brigade can carry out such life-saving measures:

injections of painkillers - a drug from the group of nitrates or narcotic analgesics;
when - fast acting diuretics;
the drug "Dopamine" and adrenaline for cardiogenic shock - if there was cardiac arrest;
to stimulate cardiac activity, the drug "Dobutamine" is administered in a diluted form;
oxygen supply using a cylinder or pillow.

Intensive therapy for cardiogenic shock significantly increases the chances of a person not dying. The algorithm for providing assistance is approximate, since the actions of doctors will depend on the patient's condition.

Treatment of cardiogenic shock in myocardial infarction and other etiological factors directly in medical institution may include the following activities:

for infusion therapy a catheter is inserted into the subclavian vein;
the reasons for the development of cardiogenic shock are diagnosed and a drug is selected to eliminate them;
if the patient is unconscious, the person is transferred to artificial ventilation;
inserting a catheter into bladder to control the amount of urine excreted;
drugs are administered to increase blood pressure;
injections of drugs of the catecholamine group ("Dopamine", "Adrenaline"), if there is a cardiac arrest;
to restore the disturbed coagulating properties of blood, "Heparin" is introduced.

In the process of carrying out measures to stabilize the state, drugs of such a spectrum of action can be used:

analgesics;
vasopressors;
cardiac glycosides;
phosphodiesterase inhibitors.

It is impossible to give the patient hemodynamic drugs and other means (with the exception of "Nitroglycerin") on their own.

If the measures of infusion therapy for cardiogenic shock do not give the desired result, an urgent decision is made regarding the surgical intervention.

In this case, coronary angioplasty can be performed with further placement of a stent and a solution to the issue of bypass surgery. The most effective method for such a diagnosis could be an emergency heart transplant, but this is almost impossible.

Unfortunately, in most cases, cardiogenic shock is fatal. But the provision of emergency care for cardiogenic shock still gives a person a chance to survive. Preventive measures does not exist.

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Cardiogenic shock is an acute left ventricular failure of extreme severity, which develops with myocardial infarction. The decrease in stroke and minute blood volume during shock is so pronounced that it is not compensated by an increase in vascular resistance, as a result of which blood pressure and systemic blood flow sharply decrease, blood supply to all vital organs is disrupted.

Cardiogenic shock most often develops within the first hours after the onset of clinical signs of myocardial infarction and much less often in a later period.

There are three forms of cardiogenic shock: reflex, true cardiogenic and arrhythmic.

Reflex shock (collapse) it is the most mild form and, as a rule, it is caused not by severe myocardial damage, but by a decrease in blood pressure in response to severe pain syndrome that occurs during a heart attack. With timely relief of pain, the course is benign, blood pressure rises rapidly, however, in the absence of adequate treatment, a reflex shock may turn into a true cardiogenic shock.

True cardiogenic shock occurs, as a rule, with extensive myocardial infarction... It is caused by a sharp decrease in the pumping function of the left ventricle. If the mass of the necrotic myocardium is 40-50% or more, then an areactive cardiogenic shock develops, in which the introduction of sympathomimetic amines does not give an effect. Mortality in this group of patients is close to 100%.

Cardiogenic shockleads to deep disturbances in the blood supply to all organs and tissues, causing microcirculation disorders and the formation of microthrombi (DIC syndrome). As a result, the functions of the brain are disrupted, the phenomena of acute renal and liver failure, acute trophic ulcers can form in the alimentary canal. Violation of blood circulation is aggravated by poor oxygenation of blood in the lungs due to a sharp decrease in pulmonary blood flow and blood shunting in the pulmonary circulation, metabolic acidosis develops.

A characteristic feature of cardiogenic shock is the formation of a so-called vicious circle. It is known that with a systolic pressure in the aorta below 80 mm Hg. coronary perfusion becomes ineffective. A decrease in blood pressure sharply worsens coronary blood flow, leads to an increase in the zone of myocardial necrosis, further deterioration of the pumping function of the left ventricle and aggravation of shock.

Arrhythmic shock (collapse) develops as a result of a paroxysm of tachycardia (more often ventricular) or acute bradyarrhythmia on the background of complete atrioventricular block. Hemodynamic disturbances in this form of shock are caused by a change in the frequency of ventricular contraction. After normalization of the heart rhythm, the pumping function of the left ventricle usually quickly recovers and the shock symptoms disappear.

The generally accepted criteria for diagnosing cardiogenic shock in myocardial infarction are low systolic (80 mm Hg) and pulse pressure (20-25 mm Hg), oliguria (less than 20 ml). In addition, the presence of peripheral signs is very important: pallor, cold clammy sweat, cold extremities. Superficial veins subside, pulse on radial arteries filamentous, the nail beds are pale, cyanosis of the mucous membranes is observed. Consciousness, as a rule, is confused, and the patient is not able to adequately assess the severity of his condition.

Treatment of cardiogenic shock. Cardiogenic shock is a formidable complication myocardial infarction, mortality in which reaches 80% or more. Its treatment is a complex task and includes a set of measures aimed at protecting the ischemic myocardium and restoring its functions, eliminating microcirculatory disorders, and compensating for impaired functions of parenchymal organs. The effectiveness of therapeutic measures in this case largely depends on the time of their beginning. Early treatment for cardiogenic shock is the key to success. The main task that needs to be solved as soon as possible is the stabilization of blood pressure at a level that provides adequate perfusion of vital organs (90-100 mm Hg).

The sequence of therapeutic measures for cardiogenic shock:

Relief of pain syndrome. Since the intense pain syndrome that occurs when myocardial infarction, is one of the reasons for lowering blood pressure, you need to take all measures to quickly and completely stop it. The most effective use of neuroleptanalgesia.

Normalization of the heart rhythm. Stabilization of hemodynamics is impossible without eliminating heart rhythm disturbances, since an acute attack of tachycardia or bradycardia in conditions of myocardial ischemia leads to a sharp decrease in shock and minute output. The most effective and safest way to relieve tachycardia in low blood pressure is electrical impulse therapy. If the situation allows drug treatment, the choice of antiarrhythmic drug depends on the type of arrhythmia. With bradycardia, which is usually caused by an acute atrioventricular block, endocardial pacing is practically the only effective remedy. Injections of atropine sulfate most often do not give a significant and lasting effect.

Strengthening the inotron function of the myocardium. If, after eliminating the pain syndrome and normalizing the rate of ventricular contraction, blood pressure does not stabilize, then this indicates the development of true cardiogenic shock. In this situation, it is necessary to increase the contractile activity of the left ventricle, stimulating the remaining viable myocardium. For this, sympathomimetic amines are used: dopamine (dopamine) and dobutamine (dobutrex), which selectively act on the beta-1-adrenergic receptors of the heart. Dopamine is administered intravenously. To do this, 200 mg (1 ampoule) of the drug is diluted in 250-500 ml of 5% glucose solution. The dose in each specific case is selected empirically, depending on the dynamics of blood pressure. Usually start with 2-5 μg / kg per minute (5-10 drops per minute), gradually increasing the rate of administration until systolic blood pressure stabilizes at 100-110 mm Hg. Dobutrex is available in 25 ml vials containing 250 mg of dobutamine hydrochloride in lyophilized form. Before use, the dry substance in the vial is dissolved by adding 10 ml of solvent, and then diluted in 250-500 ml of 5% glucose solution. Intravenous infusion begins with a dose of 5 μg / kg per minute, increasing it until a clinical effect appears. The optimal injection rate is selected individually. It rarely exceeds 40 μg / kg per 1 min, the effect of the drug begins 1-2 minutes after administration and very quickly stops after its termination due to the short (2 min) half-life.

Non-specific anti-shock measures. Simultaneously with the introduction of sympathomimetic amines in order to affect various links in the pathogenesis of shock, the following drugs are used:

glucocorticoids: prednisolone - 100-120 mg intravenously in a stream;
heparin - 10,000 IU intravenously;
sodium bicarbonate - 100-120 ml of a 7.5% solution;
rheopolyglucin - 200-400 ml, if the introduction of large amounts of liquid is not contraindicated (for example, when shock is combined with pulmonary edema); in addition, oxygen is inhaled.

Despite the development of new approaches to therapy cardiogenic shock, mortality in this complication of myocardial infarction ranges from 85 to 100%. Therefore, the best "treatment" for shock is its prevention, which consists in the rapid and complete relief of pain syndrome, heart rhythm disturbances and limitation of the heart attack zone.

- This is a critical circulatory disorder, accompanied by arterial hypotension and signs of acute deterioration in the blood supply to organs and tissues.

Cardiogenic shock occurs not only with extensive, but also with small focal myocardial infarctions.

In medicine, there are 4 options for the development and course of cardiogenic shock:

Reflex (cardiogenic shock occurs as a result of a severe pain attack)

True cardiogenic shock (occurs during a sharp decrease in myocardial contractility)

Areactive shock (the most severe variant of true cardiogenic shock, which is resistant to therapeutic measures and is forced to conduct circulatory support)

Arrhythmic shock (occurs in patients acute heart attack myocardium in case of heart rhythm disturbances).

Degrees of cardiogenic shock

There are 3 degrees of cardiogenic shock:

1 - without loss of consciousness, slight shortness of breath, edema (mild symptoms of heart failure), blood pressure within: upper 90-60; lower 50-40, pulse pressure 40-25 mm RT. Art.

2 - a sharp drop in blood pressure may occur, as a result, vital organs are less supplied, acute heart failure. blood pressure within: upper 80-40; lower 50-20, pulse pressure 30-15 mm Hg;

3 - blood pressure is very low, pulse pressure is below 15 mm Hg, acute heart failure, pulmonary edema, sharp pain during the entire cardiogenic shock.

The main symptoms of cardiogenic shock

Cardiogenic shock can develop together with acute myocardial infarction, therefore, in addition to pain behind the breastbone, a person may feel weakness, fear of death, shortness of breath, palpitations. The patient is deathly pale, covered with sticky cold sweat, the appearance of a spotted marble pattern on the skin is also characteristic. Breathing quickens, but weak. The patient wheezes, signs of pulmonary edema appear, the pulse quickens, but becomes nitivid.

Cardiogenic shock increases the likelihood of atrial fibrillation and other arrhythmias, and blood pressure drops. The abdomen is swollen, methiorism progresses. The amount of urine excreted by the patient is sharply reduced. There is a violation of the blood supply to the brain, liver, kidneys, the blood flow that feeds the myocardium worsens.

Help with cardiogenic shock

Firstly help to the patient, at which has been diagnosed should be directed to:

- to provide complete rest to the patient (to raise the lower limbs at an angle of 25%, in order to increase the flow of arterial blood to the heart);

- to carry out anesthesia with non-narcotic analgesics (baralgin, tramal, etc.);

- ventilate the room, ensure the presence of an oxygen cushion, which will provide oxygen to the tissues, especially to the heart;

- the arrived cardiological team stabilizes the pressure and heart rate;

- hospitalization after recovery from cardiac shock

Cardiac shock - a consequence of myocardial infarction, which carries a decrease in the pumping function of the myocardium, a decrease in vascular tone, an additional decrease in cardiac output. Be healthy and beautiful! (c) vitapower.ru

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General information about cardiogenic shock

Cardiogenic shock is acute failure left ventricle. The condition is extremely serious and develops against the background of myocardial infarction, more often during the first hours after the disaster. According to medical statistics, the mortality rate in this case is almost 100%. Accompany this condition characteristic signs, namely, a critical decrease in blood volume, which, in turn, leads to a sharp decrease in pressure and systemic blood flow, disruption of the blood supply to all internal organs.

Cardiogenic shock can take many forms.Depending on them, the following classification of cardiogenic shock has been adopted:

Reflex form, or collapse. The lightest form of all. The reason for it lies in the decrease in pressure in pain syndrome that occurs with a heart attack. Reflex cardiogenic shock symptoms have the following: acute pain in the heart, a significant decrease in pressure. If you help the patient, then the prognosis for him will be favorable.

True form. This form is typical for extensive infarction, when the pumping function of the left ventricle sharply decreases. The outcome depends on the degree of myocardial necrosis.
Areactive form. If, with true cardiogenic shock, necrotization occurs from 40 to 50% of the myocardium, then such a form occurs, which is almost always fatal.
Arrhythmic form, or collapse. The reason is a paroxysm of tachycardia or acute bradyarrhythmia with complete atrioventricular block. In this case, the ventricles begin to contract incorrectly, but when the pumping function of the left ventricle is restored, the symptoms are eliminated.

In addition, the classification includes 1 more type of cardiogenic shock, depending on its cause. We are talking about shock against the background of myocardial rupture. The main signs of this condition are a decrease in pressure, cardiac tamponade and an overload of its left sections, as well as a decrease in the contractile function of the myocardium.

Symptoms of cardiogenic shock

There are a number of criteria by which you can diagnose this condition in a person. The most common ones are:

systolic pressure is 80 mm Hg. Art .;
pulse pressure is 20 to 25 mm Hg. Art .;
diuresis is less than 20 ml / h;
pallor of the skin;
cold clammy sweat;
cold limbs;
collapse of superficial veins;
threadlike pulse;
pallor of the nail plates;
signs of cyanosis of the mucous membranes;
confusion of consciousness;
dyspnea;
rapid breathing with moist wheezing;
muffled heart sounds;
signs of oliguria or anuria;
marble-spotted skin tone;
facial features are pointed;
inadequate assessment of one's own state.

Clinically, shock is manifested as follows. At first, when cardiogenic shock develops, the symptoms are as follows: cardiac output decreases, as a result of which reflex sinus tachycardia and a decrease in pulse pressure develop. Against the background of these manifestations, vasoconstriction of the vessels of the skin begins, and over time - of the kidneys and brain. Large arteries are less susceptible to this process, therefore, it is from them that pressure indicators can be assessed (using palpation). In this case, intra-arterial pressure may not go beyond the norm. Then the perfusion of organs and tissues, including the myocardium, rapidly deteriorates.

Causes of cardiogenic shock

Doctors point to several reasons why this condition may develop. These include:

Left ventricular myocardial necrosis. With its defeat at 40%, people usually die, because injuries are incompatible with life.
Rupture of the papillary muscle or septum between the ventricles. Necrosis in this case is less, so the forecasts for a person are more favorable. In this case, it is very important to carry out the operation on time.
Medication therapy. Recent medical research has proven that if a patient with myocardial infarction is prematurely prescribed beta-blockers, morphine, nitrates or aCE inhibitors, this can provoke the development of shock. This is due to the fact that these drugs include such a cycle: blood pressure decreases, coronary blood flow decreases, pressure decreases even more - and so on in a circle.
Myocarditis. With inflammation of cardiomyocytes, shock can also develop.
Liquid in the heart bag. Normally, the fluid between the pericardium and the myocardium provides free movement of the heart. But if fluid accumulates, it leads to cardiac tamponade.
Pulmonary embolism. If a blood clot is rejected, it can block pulmonary artery and block the ventricle.

These are the main reasons for the development of cardiogenic shock.

Help with cardiogenic shock

Help to a patient in case of cardiogenic shock can be divided into emergency (pre-medical) and medical.

The main thing in the process of first aid is to call a team of doctors. While waiting for doctors, you need to provide a person with peace. If possible, it is best to get the person to the hospital as soon as possible, without waiting for the ambulance to be provided with the necessary treatment.

Of course a man without medical education will not be able to diagnose cardiogenic shock against the background of a heart attack, since this requires not only knowing the characteristic symptoms, but also conducting laboratory and electrocardiographic studies, which is possible only in a clinic. However, if you suspect a heart attack or cardiogenic shock while awaiting doctors, the following steps can be taken:

immediately call an ambulance;
to provide a person with complete peace;
to lay the person in such a way that his legs are above the head (this will improve the blood supply to the brain);
provide air access: close the window, make way if the blow happened on the street and a crowd gathered around the victim;
unbutton the shirt collar, loosen the tie, belt;
measure blood pressure.

Although self-administration of drugs without the recommendation of doctors is unacceptable in most cases, in such a critical situation we are talking about life and death, therefore, it is possible to give a person such drugs without a doctor's prescription:

at low pressure - Hydrocortisone, Norepinephrine, Prednisolone, Dopamine, etc.;
analgesic - any pain reliever will do.

Of course, drugs can be given only if the person is conscious.

This completes the first aid and all further measures to save a person's life and treatment are carried out by a team of cardiologists.

Help from the cardiology team

The sooner medical assistance is provided, the more chances a person has to survive. Usually therapeutic measures to treat cardiogenic shock include the following steps:

Pain relief measures. It is because of him that the pressure is critically reduced, so you need to stop the pain as soon as possible. For this, neuroleptanalgesia is used.

Restoration of heart rhythm. It is impossible to stabilize hemodynamics without a normal rhythm. It is possible to stop tachycardia with the help of electrical impulse therapy. In addition, drug therapy is used, depending on the type of arrhythmia.
Activation of the contractile function of the myocardium. If measures to eliminate pain and restore the frequency of ventricular contractions did not give the desired result and did not stabilize the pressure, this is a signal of the development of a true form of cardiogenic shock. In this case, it is necessary to increase the contraction of the left ventricle. This is achieved by amines, namely Dopamine and Dobutamine, which are administered intravenously.
Anti-shock measures. Together with amines, it is advisable to introduce other drugs. So, shown:

glucocorticoids, such as Prednisolone for intravenous administration;
Heparin for intravenous administration;
sodium bicarbonate solution;
Reopolyglucin, but provided that there is no contraindication for the introduction of a large volume of fluid.

Oxygen inhalation also belongs to anti-shock therapy, which also needs to be carried out by the patient.

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Cardiogenic shock causes

The heart has its own powerhouse called the conduction system of the heart. If a complete block of this system arises at any level, the impulses stop freely and with a certain frequency to excite the heart cells, it stops working. The rhythm of excitation of the heart is disturbed or impulses, passing through additional pathways, excite the cells "incorrectly", not in their rhythm. In this case, arrhythmia will be recorded on the graphical display of the work of the heart.

If the heart itself is damaged, the ability to fully contract the muscle is disrupted. This leads to a malnutrition of heart cells or the death of approximately 40% of cardiomyocytes (necrosis, heart attack). The larger the zone of necrosis, the higher the likelihood of developing a shock in the first hours of the disaster. If the closure of the artery is gradual, then the area of \u200b\u200bits blood supply will not suffer so immediately, and shock may develop delayed. Naturally, if the heart muscle is torn (heart attack in the interventricular septum or heart injury), the heart will also not contract adequately.

Disruption of the full functioning of cardiomyocytes can occur due to their inflammation - this condition is called myocarditis (cardiogenic shock rarely develops).

The next reason for cardiogenic shock is a situation in which the heart can contract and impulses are carried out regularly and correctly, but outside obstacles do not allow it to contract. That is, by grasping the heart from all sides and pinching it, it is possible to disrupt its pumping function. This happens when fluid accumulates in the so-called heart sac.

I must say that the structure of the heart is heterogeneous, and at least three layers are distinguished in it. Endo-, myo- and pericardium. There is space between the myo- and pericardium. It is small and contains a certain amount of liquid. This fluid makes it possible for the heart to move freely, to contract without strong friction against the pericardium. When inflammation (pericarditis) occurs, this fluid becomes larger. In some cases, it is critically high. A sharp increase in such a volume in a confined space interferes with the work of the heart, tamponade occurs.

Another mechanism of cardiogenic shock occurrence is undoubtedly pulmonary embolism. A thrombus that has flown away, in most cases, from the veins lower limbs, clogs the pulmonary artery and blocks the right ventricle of the heart. This pathogenesis of the occurrence of cardiogenic shock, in contrast to the above reasons, blocks the work of the right ventricle.

Cardiogenic shock as a result of blockages in the cardiac conduction system or rhythm disturbances, the development of pericarditis, necrosis of the heart muscle (infarction) occurs as a result of disruption of the left ventricle.

There are four main valves in the heart. If there is any acute situation with their damage, it can also lead to cardiogenic shock (for example, acutely developed stenosis or insufficiency of the mitral or aortic valves).

Cardiogenic shock classification

- True;

- Peripheral vessels expand, there is a drop in blood pressure without severe damage to the myocardium itself - cardiogenic shock, its reflex form (complicates the course of posterior myocardial infarction with a very strong pain syndrome);

- If during cardiogenic shock there is no reaction to the therapy, they speak of its areactive form;

- The presence of rhythm disturbances such as paraxism ventricular tachycardia or paroxysm of atrial flutter, as well as conduction disturbances by the type of distal complete A-V blockades and the clinic of cardiogenic shock itself - speaks of its arrhythmic form (both stroke volume and cardiac output sharply decrease);

- The rupture of the heart muscle is accompanied by a drop in reflex blood pressure, due to the outflow of blood into the heart bag and irritation of these receptors already in the pericardium, the development of cardiac tamponade, a drop in cardiac output - they speak of a form of cardiogenic shock due to myocardial rupture.

Cardiogenic shock can be graded according to its severity:

- I degree. The duration of the state of shock is less than five hours. The clinic is not bright. The drop in blood pressure is insignificant (90 mm Hg, the lower limit of systolic blood pressure). Weakly expressed tachycardia (100-110 bpm heart rate). It responds well to therapy.

- II degree. The duration of the state of shock is more than five, but less than ten hours. Symptoms of cardiogenic shock are expressed, acute left ventricular failure, accompanied by pulmonary edema, prevails. Blood pressure is significantly reduced (systolic blood pressure 80-60 mm Hg). Severe tachycardia (up to 120 per minute heart rate). The response to therapy is slow.

- III degree. The duration of the state of shock is more than ten hours. Symptoms are pronounced, the clinic is bright, rapid pulmonary edema. Blood pressure is reduced critically (less than 60 mm Hg systolic blood pressure). Tachycardia persists and intensifies (more than 120 per minute heart rate). Response to therapy is short-lived or absent.

Cardiogenic shock symptoms

The situation of occurrence of cardiogenic shock is acute, almost instantaneous. The person turns pale, turns blue, sweating appears (cold, sticky, damp skin), loses consciousness.

The systolic pressure drops sharply (it is less than 90 mm Hg for at least 30 minutes), the pulse is weak, may not be detected, during auscultation, the heart sounds are muffled, the heart beats very often, the limbs are cold, the impaired blood circulation in the kidneys is manifested by a sharp reduction in urine production - oliguria, in the lungs (in the presence of pulmonary edema) auscultatory - moist rales. Suffering of the brain can manifest itself as a complete loss of consciousness or only stunning, stupor.

The clinic for cardiogenic shock is similar to the clinic for other types of shock.

Cardiogenic shock diagnosis

It is very simple to diagnose cardiogenic shock - according to the clinic.
Diagnostics, or rather even prevention of the development of cardiogenic shock, is very important. The fatality rate of shock reaches 80 to 95%.

The zone of increased risk of developing cardiogenic shock includes patients with acutely developed heart disease or a sharp complication of an existing one. heart disease:

- with a complicated course of myocardial infarction (40% or even more cardiocytes died, the heart was remodeled immediately or in the first days of the development of myocardial infarction, there are conduction and rhythm disturbances, the development of myocardial infarction is repeated);

- patients with endocarditis and pericarditis;

- especially elderly patients;

- Patients also suffering from diabetes mellitus.

Cardiogenic shock emergency care

All treatment for cardiogenic shock is a complex of urgent measures. Emergency treatment is the main and only method for removing a patient from cardiogenic shock. The main effort is to increase blood pressure.

Treatment of cardiogenic shock includes anesthesia, oxygen inhalation, intravenous fluid administration, mandatory monitoring of hemodynamic parameters.

Drug therapy

The primary goal of all treatment is to maintain a systolic blood pressure of at least 90 mmHg. This goal is achieved by administering the following drugs, most often using syringe pumps:
Dobutrex (dosage 2.5-10 mcg / kg / min) is a selective adrenergic agonist, it has a positive inotropic action and no significant positive chronotropic effect, with minimal effect on heart rate. Dopamine (in small doses) has a pronounced chronotropic effect, increases the heart rate, increases the myocardial requirements for oxygen delivery, and can increase ischemia. The dosage is 2-10 mcg / kg / min, every 2-5 minutes the dose is increased and adjusted to 20-50 mcg / kg / min.
Norepinephrine - an adrenergic agonist, has a pronounced effect directly on the vascular tone, increasing the total vascular resistance, and to a lesser extent enhances myocardial contractility. May aggravate existing myocardial ischemia.

With cardiogenic shock, high-quality analgesic therapy is required. It is provided by both non-narcotic (a group of non-steroidal anti-inflammatory drugs is used - Analgin, Ketorol, etc.) and narcotic analgesics (Tramodol, Promedol, Morphine, Fentanyl, Buprenorphine) administered intravenously. The drugs of the nitrate group (Nitroglycerin, Nitroprusside, etc.), which are also administered intravenously to cardiac patients, relieve pain well. It is important to remember when treating with nitrates that they dilate peripheral vessels and thereby lower blood pressure.

The dosage of drugs administered for cardiogenic shock and their combinations are administered under constant monitoring of blood pressure.

An oxygen bag or portable oxygen cylinder should be in the arsenal of any ambulance. In a hospital, the patient must be put on an oxygen mask or humidified oxygen is injected through special nasal catheters.

Increased blood pressure, intravenous nitrate administration, oxygen therapy and intravenous administration of diuretics (Lasix) with adequate pain relief helps to stop pulmonary edema in II and III degree the severity of the shock. It is important again to remember that diuretics also lower blood pressure.

Surgery

With low efficiency drug therapy cardiogenic shock, the method of intra-aortic balloon counterpulsation is used, in which a balloon installed in the descending part of the aortic arch inflates during diastole and increases blood flow to the coronary arteries. This method allows you to get additional time for examining the patient and performing the operation - balloon coronary angioplasty, that is, the expansion of narrowed coronary arteries by inserting a balloon into them.

If angioplasty is ineffective, emergency coronary artery bypass grafting is performed. In refractory shock, circulatory assist is used as a "bridge" before heart transplantation.

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Is an acute left ventricular failure of extreme severity, which develops with myocardial infarction. The decrease in stroke and minute blood volume during shock is so pronounced that it is not compensated by an increase in vascular resistance, as a result of which blood pressure and systemic blood flow sharply decrease, blood supply to all vital organs is disrupted.

Most often it develops within the first hours after the onset of clinical signs of myocardial infarction and much less often in a later period.

There are three forms of cardiogenic shock: reflex, true cardiogenic and arrhythmic.

Reflex shock (collapse) is the mildest form and, as a rule, is caused not by severe myocardial damage, but by a decrease in blood pressure in response to severe pain syndrome that occurs during a heart attack. With timely relief of pain, it proceeds benignly, blood pressure rises rapidly, but in the absence of adequate treatment, a reflex shock may turn into a true cardiogenic shock.

It leads to deep disturbances in the blood supply to all organs and tissues, causing microcirculation disorders and the formation of microthrombi (DIC syndrome). As a result, the functions of the brain are disrupted, the phenomena of acute renal and hepatic failure develop, and acute trophic ulcers can form in the alimentary canal. Violation of blood circulation is aggravated by poor oxygenation of blood in the lungs due to a sharp decrease in pulmonary blood flow and blood shunting in the pulmonary circulation, metabolic acidosis develops.

Arrhythmic shock (collapse) develops as a result of a paroxysm of tachycardia (more often ventricular) or acute bradyarrhythmia on the background of complete atrioventricular block. Hemodynamic disturbances in this form of shock are caused by a change in the frequency of ventricular contraction. After the normalization of the heart rhythm, the pumping function of the left ventricle usually quickly recovers and the shock phenomena disappear.

The generally accepted criteria for diagnosing cardiogenic shock in myocardial infarction are low systolic (80 mm Hg) and pulse pressure (20-25 mm Hg), oliguria (less than 20 ml). In addition, the presence of peripheral signs is very important: pallor, cold clammy sweat, cold extremities. The superficial veins collapse, the pulse on the radial arteries is threadlike, the nail beds are pale, and cyanosis of the mucous membranes is observed. Consciousness, as a rule, is confused, and the patient is not able to adequately assess the severity of his condition.

Treatment of cardiogenic shock. Cardiogenic shock is a formidable complication myocardial infarction... mortality in which reaches 80% or more. Its treatment is a complex task and includes a set of measures aimed at protecting the ischemic myocardium and restoring its functions, eliminating microcirculatory disorders, and compensating for impaired functions of parenchymal organs. The effectiveness of therapeutic measures in this case largely depends on the time of their beginning. Early treatment for cardiogenic shock is the key to success. The main task that needs to be solved as soon as possible is the stabilization of blood pressure at a level that provides adequate perfusion of vital organs (90-100 mm Hg).

The sequence of therapeutic measures for cardiogenic shock:

Relief of pain syndrome. Since the intense pain syndrome that occurs when myocardial infarction... is one of the reasons for lowering blood pressure, you need to take all measures to quickly and completely stop it. The most effective use of neuroleptanalgesia.

Normalization of the heart rhythm. Stabilization of hemodynamics is impossible without eliminating heart rhythm disturbances, since an acute attack of tachycardia or bradycardia in conditions of myocardial ischemia leads to a sharp decrease in shock and minute output. The most effective and safest way to relieve tachycardia in low blood pressure is electrical impulse therapy. If the situation allows for drug treatment, the choice of antiarrhythmic drug depends on the type of arrhythmia. With bradycardia, which is usually caused by an acute atrioventricular block, endocardial pacing is practically the only effective remedy. Injections of atropine sulfate most often do not give a significant and lasting effect.

Cardiogenic shock: occurrence and signs, diagnosis, therapy, prognosis

Perhaps the most common and formidable complication of myocardial infarction (MI) is cardiogenic shock, which includes several types. A sudden onset of a serious condition is fatal in 90% of cases. The prospect of living with the patient appears only when, at the time of the development of the disease, he is in the hands of a doctor. And better - a whole resuscitation team, which has in its arsenal all the necessary medicines, equipment and devices for the return of a person from the “other world”. but even with all these funds, the chances of salvation are very small... But hope dies last, so doctors fight to the last for the patient's life and in other cases achieve the desired success.

Cardiogenic shock and its causes

Cardiogenic shock manifested acute arterial hypotension ... which sometimes reaches an extreme degree, is a complex, often uncontrollable condition that develops as a result of "small cardiac output syndrome" (this is how acute insufficiency of myocardial contractile function is characterized).

The most unpredictable period of time in terms of the occurrence of complications of acute widespread myocardial infarction is the first hours of the disease, because it is then at any time that myocardial infarction can turn into a cardiogenic shock, which usually occurs accompanied by the following clinical symptoms:

Disorders of microcirculation and central hemodynamics;
Acid-base imbalance;
A shift in the water-electrolyte state of the body;
Changes in neurohumoral and neuro-reflex regulatory mechanisms;
Disorders of cellular metabolism.

In addition to the occurrence of cardiogenic shock in myocardial infarction, there are other reasons for the development of this formidable condition, which include:

Figure: causes of cardiogenic shock as a percentage

Forms of cardiogenic shock

The classification of cardiogenic shock is based on the allocation of degrees of severity (I, II, III - depending on the clinic, heart rate, blood pressure, urine output, shock duration) and types of hypotensive syndrome, which can be represented as follows:

Reflex shock (hypotension-bradycardia syndrome), which develops against a background of severe pain, some experts do not actually consider a shock, since it easily docked effective methods, and the drop in blood pressure is based on reflex the influence of the affected area of \u200b\u200bthe myocardium;
Arrhythmic shock... in which arterial hypotension is due to low cardiac output and is associated with brady or tachyarrhythmia. Arrhythmic shock is presented in two forms: the predominant tachysystolic and especially unfavorable - bradystolic, arising against the background of antrioventricular block (AV) in early period THEM;
True... giving a lethality of about 100%, since the mechanisms of its development lead to irreversible changes incompatible with life;
Areactive shock in pathogenesis is an analogue of true cardiogenic shock, but is somewhat distinguished by a greater severity of pathogenetic factors, and, consequently, special severity of the course ;
Shock due to myocardial rupture... which is accompanied by a reflex drop in blood pressure, cardiac tamponade (blood flows into the pericardial cavity and interferes with cardiac contractions), overload of the left heart and a drop in the contractile function of the heart muscle.

pathologies - causes of the development of cardiogenic shock and their localization

Thus, the generally accepted clinical criteria shock with myocardial infarction and present them in the following form:

Decrease in systolic blood pressure below the permissible level of 80 mm Hg. Art. (for sufferers arterial hypertension - below 90 mm Hg. Art.);
Diuresis less than 20 ml / h (oliguria);
Pallor of the skin;
Loss of consciousness.

However, the severity of the patient's condition, who developed cardiogenic shock, can be judged more likely by the duration of the shock and the patient's response to the administration of pressor amines than by the level of arterial hypotension. If the duration of the shock state exceeds 5-6 hours, it does not stop medicines, and the shock itself is combined with arrhythmias and pulmonary edema, such a shock is called areactive .

Pathogenetic mechanisms of the occurrence of cardiogenic shock

The leading role in the pathogenesis of cardiogenic shock belongs to a decrease in the contractility of the heart muscle and reflex influences from the affected area. The sequence of changes in the left section can be represented as follows:

Reduced systolic ejection includes a cascade of adaptive and compensatory mechanisms;
Increased production of catecholamines leads to generalized vasoconstriction, especially arterial;
Generalized spasm of arterioles, in turn, causes an increase in total peripheral resistance and contributes to the centralization of blood flow;
The centralization of blood flow creates conditions for an increase in the volume of circulating blood in the pulmonary circulation and gives an additional load on the left ventricle, causing its defeat;
Elevated left ventricular end-diastolic pressure leads to the development of left ventricular heart failure .

The pool of microcirculation in cardiogenic shock also undergoes significant changes due to arterio-venous shunting:

The capillary bed is depleted;
Metabolic acidosis develops;
Severe degenerative, necrobiotic and necrotic changes in tissues and organs (necrosis in the liver and kidneys) are observed;
The permeability of the capillaries increases, due to which there is a massive exit of plasma from the bloodstream (plasmorrhage), the volume of which in the circulating blood naturally decreases;
Plasmorrhages lead to an increase in hematocrit (the ratio between plasma and red blood) and a decrease in blood flow to the cardiac cavities;
The blood supply of the coronary arteries decreases.

Events occurring in the microcirculation zone inevitably lead to the formation of new ischemic areas with the development of dystrophic and necrotic processes in them.

Cardiogenic shock, as a rule, is characterized by a rapid course and quickly takes over the entire body. Due to disorders of erythrocyte and platelet homeostasis, blood micropoliscoagulation begins in other organs:

In the kidneys with the development of anuria and acute renal failure - eventually;
In the lungs with formation respiratory distress syndrome (pulmonary edema);
In the brain with its edema and development cerebral coma .

As a result of these circumstances, fibrin begins to be consumed, which goes to the formation of microthrombi that form DIC syndrome (disseminated intravascular coagulation) and leading to bleeding (more often in the gastrointestinal tract).

Thus, the totality of pathogenetic mechanisms leads to the state of cardiogenic shock to irreversible consequences.

Treatment of cardiogenic shock should be not only pathogenetic, but also symptomatic:

With pulmonary edema, nitroglycerin, diuretics, adequate pain relief, the introduction of alcohol to prevent the formation of foamy fluid in the lungs are prescribed;
Severe pain syndrome is stopped with promedol, morphine, fentanyl with droperidol.

Urgent hospitalization under constant supervision in the intensive care unit, bypassing the emergency room! Of course, if it was possible to stabilize the patient's condition (systolic pressure 90-100 mm Hg).

Forecast and chances of life

Against the background of even a short-term cardiogenic shock, other complications can rapidly develop in the form of rhythm disturbances (tachy- and bradyarrhythmias), thrombosis of large arterial vessels, pulmonary infarctions, spleen, skin necrosis, hemorrhages.

Depending on how the blood pressure decreases, how pronounced the signs are peripheral disorders, what is the reaction of the patient's body to therapeutic measures, it is customary to distinguish cardiogenic shock moderate and heavy, which in the classification is designated as areactive... An easy degree for such a serious disease, in general, is somehow not provided.

but even in case of shock of moderate severity, there is no need to flatter yourself especially... Some positive response of the body to therapeutic effects and an encouraging rise in blood pressure up to 80-90 mm Hg. Art. can quickly change to the opposite picture: against the background of increasing peripheral manifestations, blood pressure begins to fall again.

Patients with severe cardiogenic shock have virtually no chance of survival... since they absolutely do not respond to medical measures, therefore the vast majority (about 70%) die in the first day of the illness (usually within 4-6 hours from the moment of shock). Some patients can hold out for 2-3 days, and then death occurs. Only 10 out of 100 patients manage to overcome this condition and survive. But only a few are destined to really defeat this terrible disease, since some of those who have returned from the “other world” soon die from heart failure.

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Cardiogenic shock: occurrence and signs, diagnosis, therapy, prognosis

Cardiogenic shock and its causes

Figure: causes of cardiogenic shock as a percentage

Forms of cardiogenic shock

Pathogenetic mechanisms of the occurrence of cardiogenic shock

Forecast and chances of life

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