Cardiogenic shock (patient information): Difference between revisions
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'''For the WikiDoc page for this topic, click [[Cardiogenic shock|here]]''' | |||
{{CMG}} '''Assosciate Editor(s)-In-Chief:''' [[User: Prashanthsaddala|Prashanth Saddala M.B.B.S]] | {{CMG}} '''Assosciate Editor(s)-In-Chief:''' [[User: Prashanthsaddala|Prashanth Saddala M.B.B.S]] | ||
{{Cardiogenic shock (patient information)}} | {{Cardiogenic shock (patient information)}} | ||
==Overview== | ==Overview== | ||
| Line 9: | Line 10: | ||
==What are the symptoms of Cardiogenic shock?== | ==What are the symptoms of Cardiogenic shock?== | ||
* Chest pain or pressure | * [[Chest pain]] or pressure | ||
* Coma | * [[Coma]] | ||
* Decreased urination | * [[Decreased urination]] | ||
* Fast breathing | * [[Fast breathing]] | ||
* Fast pulse | * [[Fast pulse]] | ||
* Heavy sweating, moist skin | * [[Heavy sweating]], [[moist skin]] | ||
* Lightheadedness | * [[Lightheadedness]] | ||
* Loss of alertness and ability to concentrate | * Loss of alertness and ability to concentrate | ||
* Restlessness, agitation, confusion | * [[Restlessness]], [[agitation]], [[confusion]] | ||
* Shortness of breath | * [[Shortness of breath]] | ||
* Skin that feels cool to the touch | * [[Skin that feels cool to the touch]] | ||
* Pale skin color or blotchy skin | * [[Pale skin color]] or [[blotchy skin]] | ||
* Weak (thready) pulse | * [[Weak (thready) pulse]] | ||
==What causes Cardiogenic shock?== | ==What causes Cardiogenic shock?== | ||
| Line 30: | Line 31: | ||
* A large section of heart muscle that no longer moves well or does not move at all | * A large section of heart muscle that no longer moves well or does not move at all | ||
* Breaking open (rupture) of the heart muscle due to damage from the heart attack | * Breaking open (rupture) of the heart muscle due to damage from the [[heart attack]] | ||
* Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia | * Dangerous heart rhythms, such as [[ventricular tachycardia]], [[ventricular fibrillation]], or [[supraventricular tachycardia]] | ||
* Pressure on the heart due to a build up of fluid around it (pericardial tamponade) | * Pressure on the heart due to a build up of fluid around it ([[pericardial tamponade]]) | ||
* Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve | * Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve | ||
* Tear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers) | * Tear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers) | ||
* Very slow heart rhythm (bradycardia) or problem with the electrical system of the heart (heart block) | * Very slow heart rhythm ([[bradycardia]]) or problem with the electrical system of the heart (heart block) | ||
==Diagnosis== | ==Diagnosis== | ||
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An examination will show: | An examination will show: | ||
*Low blood pressure (usually less than 90 systolic) | *[[Low blood pressure]] (usually less than 90 systolic) | ||
*Blood pressure drops more than 10 points when you stand up after lying down (orthostatic hypotension) | *Blood pressure drops more than 10 points when you stand up after lying down (orthostatic hypotension) | ||
*Weak (thready) pulse | *Weak (thready) pulse | ||
| Line 51: | Line 50: | ||
Tests include: | Tests include: | ||
*Cardiac catheterization | *[[Cardiac catheterization]] | ||
*Chest x-ray | *[[Chest x-ray]] | ||
*Coronary angiography | *[[Coronary angiography]] | ||
*Echocardiogram | *[[Echocardiogram]] | ||
*Electrocardiogram | *[[Electrocardiogram]] | ||
*Nuclear scan of the heart | *Nuclear scan of the heart | ||
| Line 62: | Line 61: | ||
Lab tests include: | Lab tests include: | ||
*Arterial blood gas | *[[Arterial blood gas]] | ||
*Blood chemistry (chem-7, chem-20, electrolytes) | *Blood chemistry (chem-7, chem-20, electrolytes) | ||
*Cardiac enzymes (troponin, CKMB) | *[[Cardiac enzymes]] ([[troponin]], CKMB) | ||
*Complete blood count (CBC) | *[[Complete blood count]] ([[CBC]]) | ||
*Thyroid stimulating hormone (TSH) | *[[Thyroid stimulating hormone]] ([[TSH]]) | ||
==When to seek urgent medical care?== | ==When to seek urgent medical care?== | ||
| Line 78: | Line 77: | ||
You may need medicines to increase blood pressure and improve heart function, including: | You may need medicines to increase blood pressure and improve heart function, including: | ||
*Dobutamine | *[[Dobutamine]] | ||
*Dopamine | *[[Dopamine]] | ||
*Epinephrine | *[[Epinephrine]] | ||
*Levosimendan | *[[Levosimendan]] | ||
*Milrinone | *[[Milrinone]] | ||
*Norepinephrine | *[[Norepinephrine]] | ||
These medicines may help in the short-term. They are not usually used for a long time. | These medicines may help in the short-term. They are not usually used for a long time. | ||
| Line 89: | Line 88: | ||
When a heart rhythm disturbance (dysrhythmia) is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include: | When a heart rhythm disturbance (dysrhythmia) is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include: | ||
*Electrical "shock" therapy (defibrillation or cardioversion) | *Electrical "shock" therapy ([[defibrillation]] or [[cardioversion]]) | ||
*Implanting a temporary pacemaker | *Implanting a temporary [[pacemaker]] | ||
*Medications given through a vein (intravenous) | *Medications given through a vein (intravenous) | ||
| Line 96: | Line 95: | ||
*Pain medicine | *Pain medicine | ||
*Oxygen | *[[Oxygen]] | ||
*Fluids, blood, and blood products through a vein (IV) | *Fluids, blood, and blood products through a vein (IV) | ||
Other treatments for shock may include: | Other treatments for shock may include: | ||
*[[Cardiac catheterization]] with [[coronary angioplasty]] and stenting | |||
*Heart monitoring to guide treatment | *Heart monitoring to guide treatment | ||
*Heart surgery (coronary artery bypass surgery, heart valve replacement, left ventricular assist device) | *Heart surgery ([[coronary artery bypass surgery]], heart valve replacement, [[left ventricular assist device]]) | ||
*Intra-aortic balloon counterpulsation (IABP) to help the heart work better | *[[Intra-aortic balloon counterpulsation]] ([[IABP]]) to help the heart work better | ||
*Pacemaker | *[[Pacemaker]] | ||
*Ventricular assist device | *[[Ventricular assist device]] | ||
===Medications to avoid=== | |||
{{MedCondContrPI | |||
= | |MedCond =cardiogenic shock|Acebutolol|Amiodarone|Atenolol|Carteolol|Esmolol|Flecainide|Nebivolol|Penbutolol|Pindolol|Propafenone|Propranolol|Sotalol|Timolol|Verapamil|Labetalol}} | ||
==Prevention of Cardiogenic shock== | ==Prevention of Cardiogenic shock== | ||
| Line 125: | Line 127: | ||
==Possible complications== | ==Possible complications== | ||
* Brain damage | * [[Brain damage]] | ||
* Kidney damage | * [[Kidney damage]] | ||
* Liver damage | * [[Liver damage]] | ||
==Sources== | ==Sources== | ||
http://www.nlm.nih.gov/medlineplus/ency/article/000185.htm | http://www.nlm.nih.gov/medlineplus/ency/article/000185.htm | ||
[[Category:Patient information]] | |||
[[Category:Cardiology]] | |||
[[Category:Cardiovascular diseases]] | |||
[[Category:Medical emergencies]] | |||
[[Category:Intensive care medicine]] | |||
[[Category:Emergency medicine]] | |||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
Latest revision as of 17:14, 9 September 2014
For the WikiDoc page for this topic, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S
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Cardiogenic shock |
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Cardiogenic shock On the Web |
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Overview
Cardiogenic shock is when the heart has been damaged so much that it is unable to supply enough blood to the organs of the body.
What are the symptoms of Cardiogenic shock?
- Chest pain or pressure
- Coma
- Decreased urination
- Fast breathing
- Fast pulse
- Heavy sweating, moist skin
- Lightheadedness
- Loss of alertness and ability to concentrate
- Restlessness, agitation, confusion
- Shortness of breath
- Skin that feels cool to the touch
- Pale skin color or blotchy skin
- Weak (thready) pulse
What causes Cardiogenic shock?
Cardiogenic shock occurs whenever the heart is unable to pump as much blood as the body needs.
The most common causes are serious heart complications. Many of these occur during or after a heart attack (myocardial infarction). These complications include:
- A large section of heart muscle that no longer moves well or does not move at all
- Breaking open (rupture) of the heart muscle due to damage from the heart attack
- Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia
- Pressure on the heart due to a build up of fluid around it (pericardial tamponade)
- Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve
- Tear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers)
- Very slow heart rhythm (bradycardia) or problem with the electrical system of the heart (heart block)
Diagnosis
An examination will show:
- Low blood pressure (usually less than 90 systolic)
- Blood pressure drops more than 10 points when you stand up after lying down (orthostatic hypotension)
- Weak (thready) pulse
To diagnose cardiogenic shock, a catheter (tube) may be placed in the lung artery (right heart catheterization). Tests may show that blood is backing up into the lungs and the heart is not pumping properly.
Tests include:
- Cardiac catheterization
- Chest x-ray
- Coronary angiography
- Echocardiogram
- Electrocardiogram
- Nuclear scan of the heart
Other studies may be done to find out why the heart is not working properly.
Lab tests include:
- Arterial blood gas
- Blood chemistry (chem-7, chem-20, electrolytes)
- Cardiac enzymes (troponin, CKMB)
- Complete blood count (CBC)
- Thyroid stimulating hormone (TSH)
When to seek urgent medical care?
Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of cardiogenic shock. Cardiogenic shock is a medical emergency.
Treatment options
Cardiogenic shock is a medical emergency. You will need to stay in the hospital, usually in the Intensive Care Unit. The goal of treatment is to find and treat the cause of shock to save your life.
You may need medicines to increase blood pressure and improve heart function, including:
These medicines may help in the short-term. They are not usually used for a long time.
When a heart rhythm disturbance (dysrhythmia) is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include:
- Electrical "shock" therapy (defibrillation or cardioversion)
- Implanting a temporary pacemaker
- Medications given through a vein (intravenous)
You may also receive:
- Pain medicine
- Oxygen
- Fluids, blood, and blood products through a vein (IV)
Other treatments for shock may include:
- Cardiac catheterization with coronary angioplasty and stenting
- Heart monitoring to guide treatment
- Heart surgery (coronary artery bypass surgery, heart valve replacement, left ventricular assist device)
- Intra-aortic balloon counterpulsation (IABP) to help the heart work better
- Pacemaker
- Ventricular assist device
Medications to avoid
Patients diagnosed with cardiogenic shock should avoid using the following medications:
- Acebutolol
- Amiodarone
- Atenolol
- Carteolol
- Esmolol
- Flecainide
- Nebivolol
- Penbutolol
- Pindolol
- Propranolol
- Sotalol
- Timolol
- Verapamil
- Labetalol
If you have been diagnosed with cardiogenic shock, consult your physician before starting or stopping any of these medications.
Prevention of Cardiogenic shock
You may reduce the risk of developing cardiogenic shock by:
- Quickly treating its cause (such as heart attack or heart valve problem)
- Preventing and treating the risk factors for heart disease, such as diabetes, high blood pressure, high cholesterol and triglycerides, or tobacco use
What to expect (Outlook/Prognosis)?
In the past, the death rate from cardiogenic shock ranged from 80 - 90%. In more recent studies, this rate has decreased to 50 - 75%.
When cardiogenic shock is not treated, the outlook is poor.