Cardiogenic shock causes: Difference between revisions
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==Overview== | ==Overview== | ||
Cardiogenic shock may occur in the setting of different [[cardiac]] conditions therefore | Cardiogenic shock may occur in the setting of different [[cardiac]] conditions, therefore assessing its source in the [[cardiac]] [[patient]] may be challenging. These [[cardiac]] conditions may involve different structures of the [[heart]] and originate different pathologies, including: [[myocardial]] or [[pericardial]] disease, [[valvular disease]], [[acute coronary syndrome]] or other mechanical injuries that may be causative or simply contributive to the shock, described below. Nevertheless, considering the predominance of [[coronary artery disease]] today, [[ACS]] is the most common cause of this type of [[shock]]. To reach the right [[diagnosis]], the clinician will have to gather information from the history and clinical examination, however, since most conditions may present with overlapping [[syndromes]], timing and changes in these findings are of uttermost importance.<ref>{{Cite book | last1 = Hasdai | first1 = David. | title = Cardiogenic shock : diagnosis and treatmen | date = 2002 | publisher = Humana Press | location = Totowa, N.J. | isbn = 1-58829-025-5 | pages = }}</ref> Auxiliary tools, such as [[echocardiography]] and [[electrocardiography]], are crucial in differentiating and identifying the possible causes of cardiogenic shock.<ref>{{Cite book | last1 = Hasdai | first1 = David. | title = Cardiogenic shock : diagnosis and treatmen | date = 2002 | publisher = Humana Press | location = Totowa, N.J. | isbn = 1-58829-025-5 | pages = }}</ref><ref name="ReynoldsHochman2008">{{cite journal|last1=Reynolds|first1=H. R.|last2=Hochman|first2=J. S.|title=Cardiogenic Shock: Current Concepts and Improving Outcomes|journal=Circulation|volume=117|issue=5|year=2008|pages=686–697|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.613596}}</ref> | ||
==Causes== | ==Causes== | ||
Revision as of 14:53, 8 May 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Cardiogenic shock may occur in the setting of different cardiac conditions, therefore assessing its source in the cardiac patient may be challenging. These cardiac conditions may involve different structures of the heart and originate different pathologies, including: myocardial or pericardial disease, valvular disease, acute coronary syndrome or other mechanical injuries that may be causative or simply contributive to the shock, described below. Nevertheless, considering the predominance of coronary artery disease today, ACS is the most common cause of this type of shock. To reach the right diagnosis, the clinician will have to gather information from the history and clinical examination, however, since most conditions may present with overlapping syndromes, timing and changes in these findings are of uttermost importance.[1] Auxiliary tools, such as echocardiography and electrocardiography, are crucial in differentiating and identifying the possible causes of cardiogenic shock.[2][3]
Causes
Life Threatening Causes
Cardiogenic Shock is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions may result in death or permanent disability within 24 hours if left untreated.
Common Causes
The most common causes of cardiogenic shock remain:[3]
However, other likewise important causes must be identified. These may be classified according to their nature into:
- Arrhythmic
- Mechanical
- Acute mitral regurgitation (papillary muscle rupture, chordae tendinae rupture)
- Free wall rupture
- Hypertrophic cardiomyopathy
- Obstruction to left ventricular filling (mitral stenosis, left atrial myxoma)
- Obstruction to left ventricular outflow tract (aortic stenosis, hypertrophic obstructive cardiomyopathy)
- Ventricular septal defect
- Myopathic
- Pharmacologic
Causes by Organ System
Causes in Alphabetical Order
Causes of Cardiogenic Shock Classified According to Underlying Pathophysiologic Mechanism
Systolic Left Ventricular Dysfunction
- Hypophosphatemia as can be seen in the refeeding syndrome)
- Septic shock with myocardial depression
Diastolic Left Ventricular Dysfunction
- Subendocardial ischemia
- Excess wall stress
Obstruction of Left Ventricular Outflow and Increased After Load
Reversal of Flow into the Left Ventricle
- Aortic insufficiency
- Endocarditis
- Aortic dissection
- Chordal rupture, from degenerative disease or trauma[4]
Inadequate Left Ventricular Filling due to Mechanical Causes
Inadequate Left Ventricular Filling due to Inadequate Filling Time
- Tachycardia mediated cardiomyopathy
Conduction Abnormalities
Mechanical Defect
- Ventricular septal defect (VSD)
- Ruptured chordae
- Myocardial rupture of the left ventricular free wall
Right Ventricular Failure
Iatrogenic
- Excess administration of vasodilators and venodilators
- Apical balloon syndrome or Takotsubo cardiomyopathy[5]
Miscellaneous
References
- ↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
- ↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
- ↑ 3.0 3.1 Reynolds, H. R.; Hochman, J. S. (2008). "Cardiogenic Shock: Current Concepts and Improving Outcomes". Circulation. 117 (5): 686–697. doi:10.1161/CIRCULATIONAHA.106.613596. ISSN 0009-7322.
- ↑ Hasdai, David. (2002). Cardiogenic shock : diagnosis and treatmen. Totowa, N.J.: Humana Press. ISBN 1-58829-025-5.
- ↑ Gianni, M. (2006). "Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review". European Heart Journal. 27 (13): 1523–1529. doi:10.1093/eurheartj/ehl032. ISSN 0195-668X.