cardiogenic shock|Definition|causes|risk factors|symptoms|Diagnostic evaluation|management |in hindi

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Today I discussed about cardiogenic shock

Cardiogenic Shock

Cardiogenic shock is a life-limiting condition that happens suddenly when your heart can’t pump enough blood to keep up with your body’s demand for it. A heart attack is the most common cause of cardiogenic shock. Without oxygen, your cells can’t function and can die. This can lead to organ failure and be fatal.



What are the symptoms?

It’s important to get immediate treatment if you have any symptoms of a heart attack, such as:
Chest pain that lasts for more than a few minutes or goes away and comes back. Your chest may feel heavy, tight, full or numb. You may feel pressure, aching, burning or squeezing. The pain may feel like heartburn. In some patients, especially women, chest pain isn't always the main symptom. Be alert for other signs listed below.

Pain or discomfort in your upper body and/or down your left arm.

Pain in the upper abdomen, throat or jaw.

Trouble breathing.

Sweating or “cold sweats.”

Fast or irregular heartbeat.

Feeling very weak, lightheaded and/or anxious.

Other symptoms related to cardiogenic shock can include:

Confusion or not being alert.

Fainting.

Very low blood pressure.

Weak pulse.

Trouble breathing.

Peeing less than normal.

Cool hands and feet.

Pale skin.

Feeling very tired.

Swelling in your belly and legs.

Poor appetite.

What causes cardiogenic shock?

A heart attack is the most common cause of cardiogenic shock. A severe heart attack can damage your heart’s main pumping chamber (left ventricle). When this happens, your body can’t get enough oxygen-rich blood.
In rare cases of cardiogenic shock, it’s the bottom right chamber of your heart (right ventricle) that’s damaged. The right ventricle pumps blood to your lungs, where it gets oxygen and then goes to the rest of your body.
Other conditions that make your heart weak and can lead to cardiogenic shock include:

Damaged heart muscle from having a heart attack.

Inflammation of your heart muscle (myocarditis).

An infection of your heart’s inner lining and valves (endocarditis).

An abnormal heart rhythm (arrhythmia).

Too much fluid or blood around your heart (cardiac tamponade).

A blood clot that suddenly blocks a blood vessel in your lung (pulmonary embolism).

A heart valve problem, such as torn muscles supporting your valve or an artificial valve not working right.

Damage to the septum that divides the left and right ventricles of your heart.

Heart failure.

Injury to your chest.

DIAGNOSIS AND TESTS

How is cardiogenic shock diagnosed?

Your healthcare provider will want to know your medical history, including symptoms you’re having that day or that you had recently. During a physical exam, they may find these signs of cardiogenic shock:

A weak pulse.

Skin that feels cold and clammy.

Low blood pressure.

An abnormal heart rhythm or heart murmur they can hear through a stethoscope.

What tests will be done to diagnose cardiogenic shock?

Several tests can help you find out if you have cardiogenic shock. These include:

Blood pressure cuff: To check for low blood pressure.

Cardiac catheterization: This procedure helps your healthcare provider find blockages in the arteries that supply blood to your heart (coronary arteries). Your provider can also use a catheterization to check the amount of blood your heart is pumping with each beat (cardiac output). A long, thin tube called a catheter is inserted in an artery through a small puncture, usually in your wrist or groin.

Electrocardiogram (ECG/EKG): A recording of your heart’s electrical activity (heart rhythm).

Echocardiogram: An ultrasound of your heart that allows your healthcare provider to determine the strength of your heart and look for any structural abnormalities such as problems with the valves.

Chest X-ray: To look for fluid in your lungs and get pictures of your heart and blood vessels.

Blood tests: To check the oxygen level in your blood and check for damage to major organs, such as your kidneys, heart and liver. They’ll also look at your electrolyte level.

MANAGEMENT AND TREATMENT

How is cardiogenic shock treated?

Cardiogenic shock is a life-threatening condition and you need emergency treatment. The most important part of treatment is improving the flow of blood and oxygen to major organs to avoid damage. Sometimes, this can be achieved with medications. In more severe cases, support devices may be needed to help your heart.
Treatment that begins in a hospital emergency room or intensive care unit may include:

Medications given through an IV to help remove excess fluid, improve blood flow, and support your heart function.

Oxygen to help your breathing.

Placement of a temporary monitoring line called a Swan-Ganz catheter, which is a special catheter that monitors the pressures inside your heart.