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Cardiogenic shock is a condition in which the heart is unable to pump enough blood to meet the needs of the entire body, due to a reduction in cardiac muscle contractions, causing a marked decrease in blood pressure, lack of oxygen in the tissues, accumulation of fluid in the lungs and reduction of the amount of blood in the coronary arteries, which are the vessels that carry blood to the heart.
This type of shock is one of the major complications of acute myocardial infarction and if not treated urgently, it can lead to death in almost 50% of cases. Thus, if cardiogenic shock is suspected, it is very important to go to the hospital immediately to confirm the diagnosis and initiate appropriate treatment.
Symptoms that may indicate possible cardiogenic shock are:
- Breathing fast;
- Exaggerated increase in heart rate;
- Sudden fainting;
- Weak pulse;
- Sweat without apparent cause;
- Pale skin;
- Cold feet and hands;
- Decrease in the amount of urine.
In cases where there is accumulation of fluid in the lungs or pulmonary edema, there may also be shortness of breath and abnormal sounds when breathing, such as wheezing, for example.
Since cardiogenic shock is more common after a heart attack, these symptoms are also accompanied by heart attack symptoms, such as a feeling of pressure in the chest, pain that spreads to the arm, shoulders or jaw, feeling of a ball throat, nausea or vomiting. See a more complete list of signs that can indicate a heart attack.
How to confirm the diagnosis
The diagnosis of cardiogenic shock needs to be made as soon as possible in the hospital and, therefore, if there is a suspicion, it is very important to go quickly to the hospital emergency room. The doctor may use some tests, such as blood pressure measurement, electrocardiogram or chest X-ray, in addition to blood tests, to confirm cardiogenic shock and start the most appropriate treatment.
Although infarction is the most frequent cause of cardiogenic shock, other problems can also cause this complication. Other possible causes include:
- Heart valve diseases;
- Right ventricular failure;
- Acute myocarditis;
- Coronary artery disease;
- Cardiac arrhythmias;
- Direct trauma to the heart;
- Intoxication of the heart by drugs and toxins.
Furthermore, in the most advanced stage of sepsis, which is a generalized infection of the body, cardiogenic shock can also occur, almost always resulting in death. Learn how to identify a case of sepsis, to start treatment and avoid cardiogenic shock.
How the treatment is done
Treatment for cardiogenic shock is usually started right at the emergency room, but then it is necessary to stay in an intensive care unit, where various types of treatment can be performed to try to relieve symptoms, improve the functioning of the heart and facilitate blood circulation.
The main treatments for cardiogenic shock are:
1. Use of medication
In addition to the serum that is applied directly into the vein to maintain hydration and nutrition, the doctor can also use:
- Vasopressors, such as adrenaline, noradrenaline, or dopamine, to treat low blood pressure; ●
- Acetylsalicylic acid, to reduce the risk of clot formation and facilitate blood circulation;
- Antiplatelet agents, such as clopidogrel or tirofiban, to prevent blood clots from forming;
- Anticoagulants, such as heparin, to decrease blood clotting ability and prevent clot formation;
- Diuretics, such as furosemide or spironolactone, to decrease the amount of fluid in the lungs.
Some medicines are applied directly into the vein, at least during the first week of treatment, and can then be taken orally, when the condition improves.
This type of treatment is done to restore circulation to the heart, if a heart attack has occurred, for example. To do this, the doctor usually inserts a catheter, which is a long, thin, catheter, through an artery, usually in the neck or groin area, into the heart to remove a possible clot and allow blood to flow back through properly. See how catheterization is done and what it is for.
ECMO, or extracorporeal membrane oxygenation, is a machine that works like an artificial lung that helps improve blood flow and oxygen delivery to the body while treating cardiogenic shock. Understand better how ECMO treatment is performed.
Surgery is usually only used in the most severe cases or when symptoms do not improve with medication or catheterization. In these cases, surgery can be used to correct a lesion in the heart or to perform a cardiac bypass, in which the doctor places another artery in the heart so that blood passes to the region that is without oxygen due to the presence of a clot.
When the functioning of the heart is very affected and no technique works, the last stage of treatment is to perform a heart transplant, however, it is necessary to find a compatible donor, which can be quite complicated. Learn more about heart transplantation.
Complications of cardiogenic shock are the failure of multiple organs such as kidneys, brain and liver, being responsible for most deaths of people hospitalized in intensive care. These complications can be avoided whenever diagnosis and treatment are made early.