An Overview of Cardiogenic Shock

Peteiro Jesus^*
*Correspondence: Peteiro Jesus, Department of Cardiology, Ehime Prefectural Niihama Hospital, Japan, Email:

Editorial

Cardiogenic shock (CS) is a medical emergency caused by insufficient blood flow caused by cardiac ventricular failure. Low urine production (less than 30 mL/hour), cold arms and legs, and a change in degree of consciousness are all signs of insufficient blood flow. A person's blood pressure and heart rate may be dangerously low. Cardiogenic shock can be caused by cardiomyopathy, arrhythmia, or mechanical causes. Acute myocardial infarction is the most common cause of CS. People can experience a variety of shocks [1].

Cardiogenic shock is treated differently depending on the aetiology, with the primary goal of improving blood supply to the body. This can be accomplished through a variety of methods, including fluid resuscitation, blood transfusions, vasopressors, and ionotropes. Attempts to open the heart's arteries may help if cardiogenic shock is caused by a heart attack. Until this can be done, an intra-aortic balloon pump or a left ventricular assist device may help. Positive inotropes (medications that improve the heart's ability to contract) may help; but, it's unclear which is optimal, and there's no convincing evidence that inotropic or vasodilating therapy reduces mortality in hemodynamically unstable patients at the moment. If blood pressure is extremely low, norepinephrine may be more effective, whereas dopamine or dobutamine may be more effective if blood pressure is only somewhat low. Even with early detection, cardiogenic shock is a tough condition to entirely reverse. Early mechanical circulatory support, early percutaneous coronary intervention, inotropes, and heart transplantation may all enhance prognosis. The attention is focused on the organs that aren't working properly (dialysis for the kidneys, mechanical ventilation for lungs dysfunction) [2].

In the United States, mortality rates have been declining. This is most likely owing to the CS being identified and treated quickly. According to some research, this could be linked to the growing use of coronary reperfusion methods such as cardiac stents. Despite this, mortality rates are still high. Multi-organ failure is linked to a greater mortality risk.

Signs and Symptoms

The presentation is the following:

• Anxiety, restlessness, and a shift in mental state are all symptoms of decreased blood supply to the brain, which leads to hypoxia.

• Low blood pressure as a result of a reduction in cardiac output.

• Due to tachycardia and reduced circulation, a fast, weak, thready pulse develops.

• Vasoconstriction and resultant hypoperfusion of the skin causes cool, clammy, and mottled skin (cutis marmorata).

• Increased jugular venous pressure causes distended jugular veins.

• If the problem persists, oliguria (poor urine output) will result from insufficient blood flow to the kidneys.

• Due to sympathetic nervous system excitation and acidosis, rapid and deeper breathing (hyperventilation) occurs.

• Hyperventilation and hypoxia cause fatigue.

• In fast and aberrant heart rhythms, there is no pulse.

• Pulmonary edoema is a condition in which fluid accumulates in the lungs as a result of inadequate cardiac pumping.

Causes

The failure of the heart to pump effectively causes cardiogenic shock. It occurs when the heart muscle is damaged, most commonly as a result of a heart attack or a myocardial contusion. Abnormal cardiac rhythms, cardiomyopathy, heart valve abnormalities, ventricular outflow obstruction (i.e. systolic anterior motion (SAM) in hypertrophic cardiomyopathy), and ventriculoseptal defects are some of the other causes. It can also be induced by a sudden decompression (for example, in an aeroplane), in which air bubbles are discharged into the bloodstream, causing heart failure (Henry's law) [3].

Diagnosis

Electrocardiogram

• An ECG can assist determine a precise diagnosis and guide treatment by revealing:

• Rhythms of the heart that are abnormal, such as bradycardia (slowed heart rate)

• Myocardial Infarction (MI) is a type of heart attack that occurs when the (ST-elevation MI, STEMI, is usually more dangerous than non- STEMIs; MIs that affect the ventricles are usually more dangerous than those that affect the atria; those affecting the left side of the heart, especially the left ventricle, are usually more dangerous than those affecting the right side, unless that side is severely compromised)

• Cardiomyopathy symptoms

Echocardiography

Poor ventricular function, symptoms of PED, rupture of the interventricular septum, a blocked outflow tract, or cardiomyopathy may be revealed by echocardiography.

Biopsy

A biopsy of the heart muscle may be required to obtain a definitive diagnosis when cardiomyopathy is suspected as the cause of cardiogenic shock.

Treatment

Treatment for cardiogenic shock can include fluid infusions or inotropic medicines if the shock is resistant to fluids. In the event of an aberrant heart rhythm, synchronised cardioversion or anti-arrhythmic medications, such as adenosine, may be used.

Positive inotropic drugs (such as dobutamine or milrinone) are used to promote contractility and treat low blood pressure by enhancing the heart's pumping capacities. If that isn't enough, a left ventricular assist device (which augments the heart's pumping function) or an intra-aortic balloon pump (which lessens the heart's workload and improves perfusion of the coronary arteries) can be explored. Mechanical ventilation or ECMO may be used to help stabilise persons with severe or refractory cardiogenic shock until they can be treated with a ventricular assist device.

Finally, if the person is stable enough and otherwise qualifies, a heart transplant or, if not suitable, an artificial heart might be implanted as a final option. More than half of patients who do not die immediately due to cardiac arrest from a lethal abnormal heart rhythm and survive to reach the hospital (who have usually suffered a severe acute myocardial infarction, which has a relatively high mortality rate in and of itself) die within the first 24 hours. Cardiogenic shock sequelae (such as cardiac arrest or subsequent irregular heart rhythms, heart failure, cardiac tamponade, a ruptured or dissecting aneurysm, or another heart attack) have an even higher death rate for individuals who are still alive at the time of admission [4,5].

Conflict of Interest

None.

References

1. Schrage, Benedikt, Peter Moritz Becher, Alina Goßling, and Gianluigi Savarese, et al. "Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock." ESC Heart Fail 8 (2021): 1295-1303.

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4. Vergara, Ruben, Renato Valenti, Angela Migliorini, and Giampaolo Cerisano, et al. "A new risk score to predict long-term cardiac mortality in patients with acute myocardial infarction complicated by cardiogenic shock and treated with primary percutaneous intervention." Am J Cardiol 119 (2017): 351-354.

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5. Basir, Mir B., Theodore L. Schreiber, Cindy L. Grines, and Simon R. Dixon, et al. "Effect of early initiation of mechanical circulatory support on survival in cardiogenic shock." Am J Cardiol 119 (2017): 845-851.

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