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| {{DiseaseDisorder infobox | | | __NOTOC__ |
| Name = Cardiogenic shock |
| | {| class="infobox" style="float: right;" |
| ICD10 = {{ICD10|R|57|0|r|50}} |
| | | style="vertical-align: middle; padding: 5px;" align=center | [[File:Siren.gif|30px|link=Cardiogenic shock resident survival guide]] |
| ICD9 = {{ICD9|785.51}} |
| | | style="vertical-align: middle; padding: 5px;" align=center | [[Cardiogenic shock resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| }}
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| {{WikiDoc Cardiology Network Infobox}} | | {{Cardiogenic shock}} |
| {{Search infobox}}
| | '''For patient information, click [[Cardiogenic shock (patient information)|here]].''' |
| {{CMG}} ; '''Associate Editor:''' {{CZ}}
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| {{Editor Help}} | | {{CMG}}; {{AE}} {{JS}} {{AEL}}, {{sali}} |
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| ==Overview== | | ==[[Cardiogenic shock overview|Overview]]== |
| '''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>
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| <ref name="Marino">
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| [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>
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| <ref name="FCCS">
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| [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>
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| <ref name="InternalMedicine"> Textbooks of Internal Medicine
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| * [http://books.mcgraw-hill.com/medical/harrisons/ Harrison's Principles of Internal Medicine] 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
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| * [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
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| * [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>
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| <ref name="Overview">
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| [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</ref>
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| 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 historical perspective|Historical Perspective]]== |
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| == Definition == | | ==[[Cardiogenic shock classification|Classification]]== |
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| 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. | | ==[[Cardiogenic shock pathophysiology|Pathophysiology]]== |
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| == Etiology == | | ==[[Cardiogenic shock causes|Causes]]== |
| 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"/>
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| <ref name="Marino"/>
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| <ref name="InternalMedicine"/>
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| <ref name="FCCS"/>
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| <ref name="Overview"/>
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| <ref name="HongKongCS">
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| [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>
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| <ref name="HongKong">
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| [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>
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| == Signs and symptoms == | | ==[[Cardiogenic shock differential diagnosis|Differentiating Cardiogenic shock from other Diseases]]== |
| * Anxiety, restlessness, [[Glasgow Coma Scale|altered mental state]] due to decreased cerebral perfusion and subsequent [[hypoxia (medical)|hypoxia]].
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| * Hypotension due to decrease in [[cardiac output]].
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| * A rapid, weak, thready pulse due to decreased circulation combined with tachycardia.
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| * Cool, clammy, and mottled skin ([[cutis marmorata]]), due to vasoconstriction and subsequent hypoperfusion of the skin.
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| * Distended [[jugular vein]]s due to increased jugular venous pressure.
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| * Oliguria (low urine output) due insufficient renal perfusion if condition persists.
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| * Rapid and deep respirations (hyperventilation) due to sympathetic nervous system stimulation and acidosis.
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| * Fatigue due to hyperventilation and hypoxia.
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| * Absent pulse in tachy[[arrhythmia]].
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| * Pulmonary Edema (fluid in the lungs) due to insufficient pumping of the heart, fluid backs up into the lungs.
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| == Diagnosis == | | ==[[Cardiogenic shock epidemiology and demographics|Epidemiology and Demographics]]== |
| === Electrocardiogram ===
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| An [[ECG|Electrocardiogram]] helps establishing the exact diagnosis and guides treatment, it may reveal:
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| * [[Cardiac arrhythmia]]s
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| * Signs of [[cardiomyopathy]]
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| === Radiology === | | ==[[Cardiogenic shock risk factors|Risk Factors]]== |
| [[Echocardiography]] may show arrhythmia, signs of PED, ventricular septal rupture (VSR), an obstructed outflow tract or cardiomyopathy. | |
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| === Swan-ganz catheter === | | ==[[Cardiogenic shock natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| The [[Swan-ganz catheter]] or Pulmonary artery catheter may assist in the diagnosis by providing information on the hemodynamics.
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| === Biopsy === | | ==Diagnosis== |
| In case of suspected cardiomyopathy a [[biopsy]] of heart muscle may be needed to make a definite [[diagnosis]].
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| ===Diagnostic criteria of cardiogenic shock===
| | [[Cardiogenic shock diagnostic evaluation|Diagnostic Evaluation]] | [[Cardiogenic shock history and symptoms|History and Symptoms]] | [[Cardiogenic shock physical examination|Physical Examination]] | [[Cardiogenic shock laboratory findings|Laboratory Findings]] | [[Cardiogenic shock electrocardiogram|Electrocardiogram]] | [[Cardiogenic shock chest x ray|Chest X Ray]] | [[Cardiogenic shock CT|CT]] | [[Cardiogenic shock MRI|MRI]] | |
| | [[Cardiogenic shock echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Cardiogenic shock other imaging findings|Other Imaging Findings]] | [[Cardiogenic shock other diagnostic studies|Other Diagnostic Studies]] |
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| A. Clinical criteria
| | ==Treatment== |
| # Systolic blood pressure <90 mm Hg
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| # Evidence of hypoperfusion
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| # Cool, clammy periphery
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| # Decreased urine output
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| # Decreased level of consciousness
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| B. Hemodynamic criteria
| | [[Cardiogenic shock medical therapy|Medical Therapy]] | [[Cardiogenic shock surgery|Surgery]] | [[Cardiogenic shock primary prevention|Primary Prevention]] | [[Cardiogenic shock secondary prevention|Secondary Prevention]] | [[Cardiogenic shock cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Cardiogenic shock future or investigational therapies|Future or Investigational Therapies]] |
| # Left ventricular end diastolic pressure or pulmonary capillary wedge pressure >15 mm Hg
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| # Cardiac index <2.2 L/min/m2
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| Reference:
| | ==Case Studies== |
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| # 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. | | [[Cardiogenic shock case study one|Case #1]] |
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| == Treatment == | | ==Related Chapters== |
| 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).
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| <ref name="IrwinRippe"/>
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| <ref name="Marino"/>
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| <ref name="FCCS"/>
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| == See also ==
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| * [[Intra-aortic balloon pump]] | | * [[Intra-aortic balloon pump]] |
| * [[Ventricular assist device]] | | * [[Ventricular assist device]] |
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| ==Notes==
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| <references/>
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| == References ==
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| *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.
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| *Marino, P. (1997) The ICU Book. (2nd edition). Philadelphia: Lippincott, Williams and Wilkins.
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| == External links ==
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| * [http://www.emedicine.com/med/topic285.htm Cardiogenic Shock] by [[eMedicine]]
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| {{Symptoms and signs}}
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| {{SIB}}
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Cardiovascular diseases]] | | [[Category:Cardiovascular diseases]] |
| [[Category:medical emergencies]] | | [[Category:Emergency medicine]] |
| [[Category:Intensive care medicine]] | | [[Category:Intensive care medicine]] |
| | | [[Category:Medical emergencies]] |
| [[de:Kreislaufstillstand]] | |
| [[es:Parada cardiorrespiratoria]]
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| [[fr:Arrêt cardio-circulatoire]]
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| [[id:Gagal jantung]]
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| [[he:דום לב]]
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| [[nl:Hartstilstand]]
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| [[ja:心停止]]
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| [[pl:Asystolia]]
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| [[pt:Choque cardiogênico]]
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| [[sr:Кардиогени шок]]
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