Cardiogenic shock

You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.

Cardiogenic shock Classification and external resources
ICD-10	R57.0
ICD-9	785.51

Cardiology Network
Discuss Cardiogenic shock further in the WikiDoc Cardiology Network
Adult Congenital
Biomarkers
Cardiac Rehabilitation
Congestive Heart Failure
CT Angiography
Echocardiography
Electrophysiology
Cardiology General
Genetics
Health Economics
Hypertension
Interventional Cardiology
MRI
Nuclear Cardiology
Peripheral Arterial Disease
Prevention
Public Policy
Pulmonary Embolism
Stable Angina
Valvular Heart Disease
Vascular Medicine

WikiDoc Resources for Cardiogenic shock
Articles
Most recent articles on Cardiogenic shock Most cited articles on Cardiogenic shock Review articles on Cardiogenic shock Articles on Cardiogenic shock in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Cardiogenic shock Images of Cardiogenic shock Photos of Cardiogenic shock Podcasts & MP3s on Cardiogenic shock Videos on Cardiogenic shock
Evidence Based Medicine
Cochrane Collaboration on Cardiogenic shock Bandolier on Cardiogenic shock TRIP on Cardiogenic shock
Clinical Trials
Ongoing Trials on Cardiogenic shock at Clinical Trials.gov Trial results on Cardiogenic shock Clinical Trials on Cardiogenic shock at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Cardiogenic shock NICE Guidance on Cardiogenic shock NHS PRODIGY Guidance FDA on Cardiogenic shock CDC on Cardiogenic shock
Books
Books on Cardiogenic shock
News
Cardiogenic shock in the news Be alerted to news on Cardiogenic shock News trends on Cardiogenic shock
Commentary
Blogs on Cardiogenic shock
Definitions
Definitions of Cardiogenic shock
Patient Resources / Community
Patient resources on Cardiogenic shock Discussion groups on Cardiogenic shock Patient Handouts on Cardiogenic shock Directions to Hospitals Treating Cardiogenic shock Risk calculators and risk factors for Cardiogenic shock
Healthcare Provider Resources
Symptoms of Cardiogenic shock Causes & Risk Factors for Cardiogenic shock Diagnostic studies for Cardiogenic shock Treatment of Cardiogenic shock
Continuing Medical Education (CME)
CME Programs on Cardiogenic shock
International
Cardiogenic shock en Espanol Cardiogenic shock en Francais
Businness
Cardiogenic shock in the Marketplace Patents on Cardiogenic shock
Experimental / Informatics
List of terms related to Cardiogenic shock

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884 ; Associate Editor: Cafer Zorkun, M.D., Ph.D. [2] Phone:617-525-7431

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Cardiogenic shock is based upon an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively.^{[1] [2] [3] [4] [5]}

Since this is a category of shock there is insufficient perfusion of tissue (i.e. the heart) to meet the required demand for oxygen and nutrients. This leads to cell death from oxygen starvation, hypoxia. Because of this it may lead to cardiac arrest (or circulatory arrest) which is an acute cessation of cardiac pump function.^[4]

Definition

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 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. ^{[1] [2] [4] [3] [5] [6] [7]}

Signs and symptoms

• Anxiety, restlessness, altered mental state due to decreased cerebral perfusion and subsequent 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 veins 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 tachyarrhythmia.
• Pulmonary Edema (fluid in the lungs) due to insufficient pumping of the heart, fluid backs up into the lungs.

Diagnosis

Electrocardiogram

An Electrocardiogram helps establishing the exact diagnosis and guides treatment, it may reveal:

• Cardiac arrhythmias
• 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.

Diagnostic criteria of cardiogenic shock

A. Clinical criteria

1. Systolic blood pressure <90 mm Hg
2. Evidence of hypoperfusion
3. Cool, clammy periphery
4. Decreased urine output
5. Decreased level of consciousness

B. Hemodynamic criteria

1. Left ventricular end diastolic pressure or pulmonary capillary wedge pressure >15 mm Hg
2. Cardiac index <2.2 L/min/m2

Reference:

1. Data from Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999; 341 (9) : 625–34.

Treatment

In cardiogenic shock: depending on the type of myocardal infarction one can infuse fluids or in shock refractory to infusing fluids inotropica. In case of cardiac arrhythmia several anti-arrhythmic agents may be administered, i.e. adenosine, verapamil, amiodarone, β-blocker. Positive 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 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). ^{[1] [2] [3]}

See also

• Intra-aortic balloon pump
• Ventricular assist device

Notes

1. ↑ ^{1.0 1.1 1.2} Irwin and Rippe's Intensive Care Medicine by Irwin and Rippe, Fifth Edition (2003), Lippincott Williams & Wilkins, ISBN 0-7817-3548-3
2. ↑ ^{2.0 2.1 2.2} The ICU Book by Paul Marino MD, PhD, Second Edition (1997), Lippincott Williams & Wilkins, ISBN 0-683-05565-8
3. ↑ ^{3.0 3.1 3.2} Fundamental Critical Care Support, A standardized curriculum of Critical Care by the Society of Critical Care Medicine
4. ↑ ^{4.0 4.1 4.2} Textbooks of Internal Medicine
   • Harrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
   • Cecil Textbook of Medicine by Lee Goldman, Dennis Ausiello, 22nd Edition (2003), W.B. Saunders Company, ISBN 0-7216-9652-X
   • 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
5. ↑ ^{5.0 5.1} 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
6. ↑ Cardiogenic shock Department of Anaesthesia and Intensive Care of The Chinese University of Hong Kong
7. ↑ 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

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

• Cardiogenic Shock by eMedicine

v • d • e Symptoms and signs (R00-R69, 780-789)
Circulatory and respiratory systems	Tachycardia - Bradycardia - Palpitation - Heart murmur - Nosebleed - Hemoptysis - Cough - abnormalities of breathing (Dyspnea, Orthopnoea, Stridor, Wheeze, Cheyne-Stokes respiration, Hyperventilation, Mouth breathing, Hiccup, Bradypnea, Hypoventilation) - Chest pain - Asphyxia - Pleurisy - Respiratory arrest - Sputum - Bruit
Digestive system and abdomen	Abdominal pain - Acute abdomen - Nausea - Vomiting - Heartburn - Dysphagia - Flatulence - Burping - Fecal incontinence - Encopresis - Hepatomegaly - Splenomegaly - Hepatosplenomegaly - Jaundice - Ascites - Fecal occult blood - Halitosis
Skin and subcutaneous tissue	disturbances of skin sensation (Hypoesthesia, Paresthesia, Hyperesthesia) - Rash - Cyanosis - Pallor - Flushing - Petechia - Desquamation - Induration
Nervous and musculoskeletal systems	abnormal involuntary movements (Tremor, Spasm, Fasciculation, Athetosis) - Gait abnormality - lack of coordination (Ataxia, Dysmetria, Dysdiadochokinesia, Hypotonia) - Tetany - Meningism - Hyperreflexia
Urinary system	Dysuria - Vesical tenesmus - Urinary incontinence - Urinary retention - Oliguria - Polyuria - Nocturia
Cognition, perception, emotional state and behaviour	Anxiety - Somnolence - Coma - Amnesia (Anterograde amnesia, Retrograde amnesia) - Dizziness/Vertigo - smell and taste (Anosmia, Ageusia, Parosmia, Parageusia)
Speech and voice	speech disturbances (Dysphasia, Aphasia, Dysarthria) - symbolic dysfunctions (Dyslexia, Alexia, Agnosia, Apraxia, Acalculia, Agraphia) - voice disturbances (Dysphonia, Aphonia)
General symptoms and signs	Fever (Hyperpyrexia) - Headache - Chronic pain - Malaise - Fatigue - Fainting (Vasovagal syncope) - Febrile seizure - Shock (Cardiogenic shock) - Lymphadenopathy - Edema (Peripheral edema, Anasarca) - Hyperhidrosis (Sleep hyperhidrosis) - Delayed milestone - Failure to thrive - food and fluid intake (Anorexia, Polydipsia, Polyphagia) - Cachexia - Xerostomia - Clubbing

de:Kreislaufstillstandfr:Arrêt cardio-circulatoire

id:Gagal jantung he:דום לב nl:Hartstilstand ja:心停止sr:Кардиогени шок

WikiDoc Help Menu Quick Start.. Get Started Here! How to Login How to Search Pages How to Start a New Page How to Edit a Page Cheat Sheet Editing basics Learning Basic Formatting How to make Links in WikiDoc & to External Sites How to Make Lists How to Ignoring Formatting Adding References or Footnotes to Articles Tracking Changes You Have Made How to Put an Article Into a Category When Multiple Topics Should Go To The Same Page (MI, Acute MI, AMI) Using Redirection Advanced editing How to Make Tables How to Insert Images and Other Media How to Add Video Help:How to Make Columns Web Colors How To Make Templates How to Move Pages Inserting Dynamic Dates and Times Inserting WikiDoc Statistics Editing the Table of Contents Communicating your edits Let others know what you changed: The importance of Edit Summaries Minor Edits Edit Conflicts Help Videos You Can Watch Getting Started Video

Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .