Cardiogenic shock presents when there is a severe and sudden reduction in the contractility and output of the heart. It is usually caused by a massive heart attack. The condition leads to inadequate tissue perfusion.

Why does this happen and how may it affect the patients health?

This usually happens when a massive heart attack causes damage to more than 50% of the heart muscle of the left ventricle (lower heart chamber).

This is seen more often in

  • The elderly
  • Anterior infarction (heart attack involving the front side of the heart)
  • Females
  • Prior high blood pressure

In rare instances, cardiogenic shock may be the result of damage to the heart muscle due to trauma (external injury).

Overdose of medications e.g. Beta-blockers (drugs that slow heart rate down) or calcium antagonists may precipitate this condition.

Other heart conditions that may lead to this, include

  • Ventricular septal defects (birth defects of heart)
  • Valve lesions
  • Inflammation of the heart muscle (myocarditis)

What symptoms may the patient experience?

  • Patient has a poor (weak) rapid pulse
  • Patient is also sweaty and severely distressed
  • The patients blood pressure is severely depressed (low blood pressure)
  • Cool extremities
  • Urinary output is reduced
  • There is usually fluid on the lungs (pulmonary oedema), which causes rapid shallow breathing

How is the diagnosis made and what special investigations are required?

Because of the life-threatening nature of cardiogenic shock, several invasive and non-invasive investigations may be required as indicated, which may include

  • ECG (may show large Q-waves, indicating a major heart attack, or increased heart enzymes)
  • Chest x-ray
  • Echocardiogram
  • Transesophageal echocardiogram
  • Heart catheterisation (angiogram)
  • Drug identification (if patient was using any drugs)

What is the treatment and prognosis?

Correct any irregular heart rate and rhythm.

The outcome largely depends on the

  • Degree of functional left ventricle (lower heart chamber) available
  • Treatment, which is aimed at maintaining circulation until some recovery of heart muscle takes place

These patients need to be treated in a cardiac intensive care unit.

The overall prognosis is poor.

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