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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''']] |
| }}
| | |} |
| | {{Cardiogenic shock}} |
| | '''For patient information, click [[Cardiogenic shock (patient information)|here]].''' |
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| {{Search infobox}} | | {{CMG}}; {{AE}} {{JS}} {{AEL}}, {{sali}} |
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| {{CMG}}
| | ==[[Cardiogenic shock overview|Overview]]== |
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| {{Editor Help}}
| | ==[[Cardiogenic shock historical perspective|Historical Perspective]]== |
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| ==Overview== | | ==[[Cardiogenic shock classification|Classification]]== |
| '''Cardiogenic shock''' is defined as an inadequate [[cardiac output]] to maintain adequate perfusion of vital organs to meet ongoing demands for oxygenation. Cardiogenic shock is due to inadequate left ventricular function (such as in [[congestive heart failure]])or inadequate left ventricular filling (such as in [[cardiac tamponade]] or [[mitral stenosis]] with tachycardia). In so far as the course of treatment differs substantially, cardiogenic shock should be distinguished from [[septic shock]] and [[neurogenic shock]].
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| == Definition == | | ==[[Cardiogenic shock pathophysiology|Pathophysiology]]== |
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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. In clinical trials, cardiogenic shock has been defined as follows <ref>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.</ref> | | ==[[Cardiogenic shock causes|Causes]]== |
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| ===Clinical criteria=== | | ==[[Cardiogenic shock differential diagnosis|Differentiating Cardiogenic shock from other Diseases]]== |
| # 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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| ===Hemodynamic criteria=== | | ==[[Cardiogenic shock epidemiology and demographics|Epidemiology and Demographics]]== |
| # 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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| == Pathophysiology of Cardiogenic Shock == | | ==[[Cardiogenic shock risk factors|Risk Factors]]== |
| Cardiogenic shock can be a complication of the follwoing conitions:
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| *[[Acute MI]], more often [[ST elevation MI]]. Anterior MI with pronounced left ventricular dysfunction, posterior MI with acute mitral regurgitation, and inferior MI wiht [[right ventricular infarct]] physiology can be associated with cardiogenic shock.
| | ==[[Cardiogenic shock natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| *[[Tachyarrhythmia]]s resulting in inadequate ventricular filling times and inadequate forward [[cardiac output]].
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| *[[Congestive heart failure]]
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| *[[Cardiomyopathy]]
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| *[[Valvular heart disease]] including [[aortic stenosis]], [[mitral stenosis]] with [[tachycardia]] and inadequate diastolic filling time.
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| *[[Aortic dissection]]
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| *[[Hypertrophic obstructive cardiomyopathy]] with systolic anterior motion (SAM)
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| *[[Ventricular septal defect]]
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| *[[Cardiac tamponade]]
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| *Iatrogenic due to excess administration of vasodilators and venodilators
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| == Diagnosis == | | ==Diagnosis== |
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| === Symptoms ===
| | [[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]] | |
| * [[Anxiety]], restlessness, and an [[Glasgow Coma Scale|altered mental state]] may be present due to decreased cerebral perfusion and ensuing [[hypoxia (medical)|hypoxia]].
| | [[Cardiogenic shock echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Cardiogenic shock other imaging findings|Other Imaging Findings]] | [[Cardiogenic shock other diagnostic studies|Other Diagnostic Studies]] |
| * [[Fatigue]] may be present due to the work of breathing and [[hypoxia]].
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| ===Physical Examination=== | | ==Treatment== |
| ====Vitals====
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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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| ====Neck====
| | [[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]] |
| * Distended [[jugular vein]]s due to increased [[jugular venous pressure]].
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| ====Skin====
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| * Cool, clammy, and mottled skin ([[cutis marmorata]]), due to vasoconstriction and subsequent hypoperfusion of the skin.
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| ====Lungs====
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| * Rapid and deep respirations (hyperventilation) due to sympathetic nervous system stimulation and acidosis.
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| * [[Oliguria]] (low urine output) due insufficient renal perfusion if condition persists.
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| * Absent pulse in tachyarrhythmia.
| | ==Case Studies== |
| * [[Pulmonary Edema]] (fluid in the lungs) due to insufficient pumping of the heart, fluid backs up into the lungs.
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| === Electrocardiogram ===
| | [[Cardiogenic shock case study one|Case #1]] |
| 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 === | | ==Related Chapters== |
| [[Echocardiography]] may show arrhythmia, signs of PED, ventricular septal rupture (VSR), an obstructed outflow tract or cardiomyopathy.
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| === Swan-ganz catheter ===
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| The [[Swan-ganz catheter]] or Pulmonary artery catheter may assist in the diagnosis by providing information on the hemodynamics.
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| === Biopsy ===
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| In case of suspected cardiomyopathy a [[biopsy]] of heart muscle may be needed to make a definite [[diagnosis]].
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| == Treatment ==
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| In cardiogenic shock: depending on the type of myocardal infarction one can infuse fluids or in shock refractory to infusing fluids, inotropes should be administered. 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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| == Sources ==
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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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| ==References==
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| {{reflist|2}}
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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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| {{Intensive care medicine}}
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| {{SIB}}
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Cardiovascular diseases]] | | [[Category:Cardiovascular diseases]] |
| | [[Category:Emergency medicine]] |
| | [[Category:Intensive care medicine]] |
| [[Category:Medical emergencies]] | | [[Category:Medical emergencies]] |
| [[Category:Intensive care medicine]]
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| [[Category:Emergency medicine]]
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| [[de:Kreislaufstillstand]]
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| [[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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