Cardiogenic shock - a sudden disruption of the main pump of the body, that is the heart, because the problems in himself or vessels supplying the heart.From this seemingly simple definition of those levels immediately visible lesions in which there may be cardiogenic shock.Significant damage directly to the heart (to review the topic enough to take it as a basis for the pumping function) - the blood stops moving through the vessels, and thus delivered to the most important organs such as the brain and kidneys.On the other hand, lost its tone, blood vessels are not able to deliver oxygen to the blood of these bodies and to the heart.Of course, it looks rather simplistic.In fact, this process involves deep mechanisms and the close relationship between the bodies.
in the aorta, one of your cut, the heart pushes out a certain amount of blood, referred to as stroke volume.One minute, cutting an average of 70 times, it pumps the so-called minute volume.These are the main paramete
Cardiogenic shock causes
The heart has its own power plant, called conduction system of the heart.If any level occurs complete block of the system, the pulses cease freely and with a certain frequency of the exciting heart cells, it stops working.Disturbed heart rhythm or excitation pulses passing through additional ways excite cells "wrong" not in my rhythm.The graphical display of the heart is in this case fixed arrhythmia.
If the damage of the heart is disturbed possibility of full muscle contraction.This results in malnutrition death of heart cells or approximately 40% of cardiomyocytes (death, heart attack).The larger area of necrosis, the higher the probability of shock in the early hours of the disaster happened.If a gradual closing of the artery, the blood supply to the area it will not suffer immediately, and shock may develop delayed.Of course, if the heart muscle is broken (a heart attack in the interventricular septum or trauma of the heart) heart just will not be reduced adequately.
Violation complete the work cardiomyocytes may occur as a result of inflammation - a condition called myocarditis (rarely develops cardiogenic shock).
Another cause of cardiogenic shock, consider a situation in which the heart can be reduced and the pulses are carried out regularly and correctly, but he was not allowed to fall outside obstacles.That is, grasping the heart from all sides and clip it is possible to achieve a violation of its pumping function.This occurs when liquid accumulates in the so-called heart bag.
must say that the structure of the heart is inhomogeneous, and it allocated a minimum of three layers.Endo-, myo- and pericardium.Between myocardial and pericardium is a space.It is small, and it contains a certain amount of liquid.This fluid makes it possible to freely move the heart, to contract without a strong friction pericardium.If there is inflammation (pericarditis) this fluid becomes greater.In some cases - many critically.The sharp rise in the volume of the closed space interfere with heart tamponade occurs.
to another mechanism of occurrence of cardiogenic shock is certainly true pulmonary embolism.Thrombus, flown away, in most cases, from the veins of the lower extremities, occludes the pulmonary artery and blocks the right ventricle.This pathogenesis occurrence cardiogenic shock, unlike the above reasons blocks the right ventricle.
Cardiogenic shock as a result of blockages in the conduction system of the heart or rhythm disorders, development of pericarditis, myocardial necrosis (heart attack) occurs due to malfunction of the left ventricle.
the heart is divided into four main valve.If there is any urgent situation with their damage - it can also lead to cardiogenic shock (for example, developed acute stenosis or mitral insufficiency or aortic valves).
Cardiogenic shock classification
- peripheral blood vessels dilate, blood pressure drop occurs without the heavy defeat of the myocardium - cardiogenic shock, its reflexive form (difficult for the rear of myocardial infarction with a very strong pain);
- If cardiogenic shock is no reaction to the therapy - talking about his unresponsiveness form;
- The presence of arrhythmias as paroxysms of ventricular tachycardia or paroxysm of atrial fibrillation, as well as violation of the conduction-type distal complete AV block and clinics of cardiogenic shock - says about his arrhythmic form (decreases sharply as the stroke volume and cardiac output);
- Break heart muscle is accompanied by a drop in blood pressure reflex due to the outpouring of blood in the heart bag and irritation of these receptors has the pericardium, the development of cardiac tamponade, a drop in cardiac output - say about the form of cardiogenic shock due to myocardial rupture.
Cardiogenic shock is possible to grade severity:
- I degree.The duration of a state of shock for at least five hours.The clinic is not bright.A slight drop in blood pressure (90 mm Hg lower limit of the systolic blood pressure).Weakly expressed tachycardia (100-110 min. Heart rate).It responds well to therapy.
- II degree.The duration of shock more than five but less than ten hours.Symptoms are expressed cardiogenic shock, acute left ventricular failure dominates, accompanied by pulmonary edema.Blood pressure was significantly reduced (systolic blood pressure of 80-60 mmHg).Severe tachycardia (up to 120 per minute heart rate).Response to therapy slowed.
- III degree.The duration of a state of shock over ten hours.The symptoms are pronounced, the clinic is bright, rapid swelling of the lungs.Blood pressure is critically reduced (less than 60 mm Hg systolic blood pressure).Preserving and strengthening tachycardia (more than 120 per minute heart rate).Response to therapy was short-lived or nonexistent.
Cardiogenic shock symptoms
situations of acute cardiogenic shock, almost instantly.Man pales turns blue, there sweating (cold, clammy, moist skin), loses consciousness.
sharply reduced systolic blood pressure (it is less than 90 mm Hg. V. At least 30 minutes), the pulse is weak, can not be detected on auscultation - heart sounds dull, the heart beats very often, cold extremities, poor circulation in the kidney manifested by a sharp cut-backurine output - oligouriya in the lungs (pulmonary edema when available) auscultation - crackles.The suffering of the brain can occur complete loss of consciousness, or a stunning, sopor.
Clinic cardiogenic shock is similar to other types of clinic shock.
Cardiogenic shock diagnosis
diagnose cardiogenic shock it is very simple - at the clinic.
Diagnostics, or rather even prevent the development of cardiogenic shock is very important.Percentage lethal shock reaches 80 to 95%.
in the zone of increased risk of cardiogenic shock include patients with acute-onset heart disease or sharply to complications existing heart disease:
- with complicated myocardial infarction (40% or more cardiocytes died, was heart remodeling at once or in the first daysof heart attack, there are conduction abnormalities and rhythm, re-myocardial infarction);
- patients with endocarditis, and pericarditis;
- especially elderly patients;
- patients suffering from diabetes also.
Cardiogenic shock Emergency
All treatment of cardiogenic shock is a complex of urgent measures.Emergency treatment is the main and the only method of removing the patient from cardiogenic shock.Major efforts - increased blood pressure.
Treatment of cardiogenic shock involves anesthesia, inhalation of oxygen, intravenous fluids, mandatory monitoring of hemodynamic parameters.
Naiperveyshaya goal of all treatment - to maintain the numbers of systolic pressure of not less than 90 mm HgThis goal is achieved through the introduction of these drugs, often with the help of syringe pumps:
Korotrop (dosage of 2.5-10 mg / kg / min) - a selective adrenoagonists, it has a positive inotropic effect or a significant positive chronotropic effect with minimumeffect on the heart rate.Dopamine (in small doses) has expressed chronotropism, increases heart rate, increases myocardial demand for oxygen delivery, may exacerbate ischemia.The dosage of 2-10 mg / kg / min., Every 2-5 minutes and adjusted to increase the dose of 20-50 ug / kg / min.Norepinephrine
- adrenoagonists has a pronounced effect directly on vascular tone, increasing the total vascular resistance, to a lesser degree enhances myocardial contractility.It may aggravate pre-existing myocardial ischemia.
In cardiogenic shock required quality pain therapy.It is provided as a non-narcotic (used group of nonsteroidal antiinflammatory drugs - Analgin, Ketorol it.d.) and narcotic analgesics (Tramodol, Promedol, morphine, fentanyl, buprenorphine) administered intravenously.Well relieve pain drugs of nitrates (nitroglycerin, nitroprusside, etc.) administered as intravenous cardiac patients.It is important to keep in mind when treating nitrates that they extend peripheral vessels and reduce this blood pressure.
dosage administered drugs in cardiogenic shock, and combinations thereof are entered under the constant monitoring of blood pressure.
oxygen tanks or portable oxygen tank should be in the arsenal of any emergency.In a hospital a patient is required to wear an oxygen mask or oxygen is injected through special humidified nasal catheters.
Increased blood pressure, intravenous nitrates, oxygen therapy and the appointment of intravenous diuretics (Lasix) with adequate analgesia helps to stop pulmonary edema during II and III of the severity of the shock.It is important again to remember that diuretics also lower blood pressure.
When the low efficiency of drug therapy of cardiogenic shock method used IABP in which the balloon is mounted in the descending part of the aortic arch is inflated during diastole and increases blood flow in coronary arteries.This method allows you to get more time for patient examination and surgery - Coronary angioplasty balloon, ie the expansion of narrowed coronary arteries, in giving them a balloon.
With the ineffectiveness of angioplasty performed emergency coronary artery bypass grafting.When used refractory shock circulatory support as a "bridge" to heart transplantation.