Cardiogenic shock

Is anyone in your family suffering from rapid breathing, sweating, and coldness of hands and feet? Seek medical care immediately, for these are the classic signs of a Cardiogenic shock – an acute cardiac condition that might lead to coma or even death in the absence of immediate treatment. Read and know all about the causes, symptoms, diagnosis, and treatment of this heart disorder.

What is Cardiogenic shock?

It is a condition that occurs due to the inability of the heart to pump enough blood to satisfy the requirements of the human body.

Cardiogenic shock ICD 9 code

The ICD 9 code for this disorder is 785.51.

Cardiogenic shock Incidence

The rate of incidence associated with this disorder is not available. However, the rate of the disorder associated with in-hospital onset has dropped over the years while the rate has remained constant at approximately 2.3% for shock-on-admission cases.

Cardiogenic shock Symptoms

The condition usually results in problems like:

• Mental confusion
• Sweating
• Weak pulse
• Cold hands or feet
• Pale skin
• Acute shortness of breath
• Rapid respiration
• Loss of alertness
• Inability to concentrate
• Light headedness
• Rapid, sudden heartbeat (Tachycardia)
• Fainting or loss of consciousness
• Non-existent or less-than-normal urinary output
• Coma

These are some common symptoms of heart attack that are often experienced before Cardiogenic shock occurs:

• Nausea and vomiting
• Fainting
• Persistent pain in the upper abdominal region
• Increase in the number of episodes of chest pain
• Sweating
• Shortness of breath
• Impending sense of doom

Patients also experience fullness, pressure or a squeezing pain in the middle of the chest that persists for over a few minutes. The pain extends beyond the chest and can be experienced in the arms, shoulder, back or even the jaw and teeth.

Seeking medical attention immediately after experiencing the signs or symptoms of a heart attack would help you lower the risk of developing Cardiogenic shock.

What Causes Cardiogenic shock?

The problem may arise due to various causes like:

• Myocarditis, or an inflammation of the heart muscle
• Endocarditis, or an infection of the cardiac valves
• Poisoning with certain substances or drug overdose, which affect the ability of the heart to pump properly

However, it most commonly arises due to an acute heart attack, which damages the left ventricle – the main pumping-chamber of the heart.

A heart attack results from the obstruction of one or more coronary arteries that supply oxygenated blood to the heart. Over time, the accumulation of cholesterol can lead to the narrowing of a coronary artery. These cholesterol- buildups, also known as plaques, in arteries all over the body is known as atherosclerosis.

At the time of a heart attack, one of the plaques can suffer a tear. A blood clot may develop at the site of tear and obstruct the flow of blood through the coronary artery. The cardiac muscles may weaken and progress into a Cardiogenic shock in the absence of circulation of oxygen-rich blood to that particular area of the heart.

In rare cases, the problem can also arise due to the damaging of the right ventricle of the heart. The right ventricle directs blood to the lungs to make it oxygenated (rich in oxygen) and then pumps it to the remaining areas of the human body. Damage to the right ventricle makes it difficult for the heart to pump blood to the lungs effectively. The body fails to receive enough oxygen as a result.

Cardiogenic shock Treatment

The aim of treatment of this problem is to cure the underlying cause of the disorder that would save the life of patients. Treatment focuses on repairing the damage to the cardiac muscles and other organs resulting from a lack of oxygen. Medical cure may involve any of the following:

Medications

Drugs are used to improve the flow of blood through the heart and increase the ability of the heart to pump normally. Medicines used for treating this purpose include:

Thrombolytics

These medications, also known as clot busters, help dissolve a blood clot that obstructs the flow of blood to the heart. The sooner a patient is administered a thrombolytic drug after a heart attack, the higher is the chance of survival for the sufferer and the lower the risk of damage to the heart. Such medications are generally given if there is an absence of emergency cardiac catheterization.

Inotropic agents

Medicines like epinephrine or dopamine may be given to patients to support and improve their cardiac function, until other curative methods begin to work.

Aspirin

These are usually administered by emergency medical professionals as soon as they arrive on the scene to help patients manage the condition until they are shifted to a hospital. Aspirin lowers the clotting of blood and helps retain normal flow of blood through a narrowed artery. If your doctor instructs you to do so, take an aspirin if you are experiencing the symptoms of a heart attack and waiting for medical caregivers to arrive.

Superaspirins

These are medicines that are similar to aspirin and usually administered to patients in the emergency room to prevent the formation of new clots. Such drugs include clopidogrel (Plavix) and platelet glycoprotein IIIa or IIb receptor blockers.

Blood-thinning drugs

These involve medications like Heparin to reduce the risk of blood to form dangerous clots. Heparin is generally used during the first few days following a heart attack and is administered through an intravenous injection.

Emergency life support

It is seen as essential for the majority of Cardiogenic shock sufferers. It involves administration of additional oxygen to a patient to help them breathe and reduce the risk of damage to their muscles and vital organs. If required, patients might be connected to a ventilator (breathing apparatus). They are likely to be provided fluids and medications through an intravenous (IV) line in their arm.

Medical procedures

These are techniques used by doctors to restore the flow of blood through the heart. These include:

Balloon Pump

Based on the health status of patients, doctors may prefer to place a balloon pump in the primary artery (aorta) of their heart. This apparatus expands and contracts to simulate the pumping action of the heart and helping blood to flow through.

Angioplasty and stenting

The signs of a cardiogenic shock generally improve once the flow of blood is restored through an obstructed artery. An angioplasty, carried out in an emergency setting, opens obstructed coronary arteries and allows free movement of blood to the heart. In this process, doctors place a long, thin tube (known as catheter) to an obstructed artery in the heart. The catheter is fitted with a special balloon. Once the tube is set in place, the balloon is inflated briefly to open up the blocked cardiac artery. A metal mesh stent may be introduced at the same time into the artery to let it remain open for a long time, thus helping restore the flow of blood to the heart. In the majority of sufferers, physicians are likely to insert a stent coated with a slow-releasing drug to allow the artery to remain open.

Cardiogenic shock and Surgery

If medicines and other curative approaches fail to cure the condition, physicians may consider a surgical treatment as a possible remedy. This involves:

Heart pumps

These are mechanical devices that are also known as Ventricular Assist Devices (VADs). These instruments are inserted into the abdomen and fixed to a weakened heart to make it pump. Inserted cardiac pumps are found to be effective in improving the survival rate of the population that is suffering from end-stage heart failure, waiting for a new heart or non-eligible for heart transplantation.

Coronary artery bypass surgery

It involves sewing arteries or veins in position at a region beyond a narrowed or blocked coronary artery. This helps restore the flow of blood to the heart. Patients are likely to be recommended this surgical process after their heart is found to have recovered from an attack.

Cardiogenic shock Diagnosis

The condition is generally detected in an emergency setting. Physicians tend to check the signs of this condition and perform additional medical exams to detect the actual cause of the problem. The tests that are commonly used for the diagnosis of this disease include:

• Blood tests – Testing of blood samples helps check any possible damage of the liver or kidneys, detect the signs of a heart attack or detect any signs of a possible cardiac infection.
• Chest X-ray – An X-ray image of the chest can help physicians check the shape and size of the heart as well as its blood vessels.
• Electrocardiogram (ECG) – It is the first medical exam that is conducted to detect a heart attack that has occurred or about to occur.
• Coronary Catheterization (Angiogram) – This exam helps whether the coronary arteries are blocked or narrowed.
• Echocardiogram – The test involves use of audio waves to create an image of the heart. It helps detect whether a cardiac section has suffered damage due to a heart attack and is not pumping in a normal way.

Cardiogenic shock Complications

Unless treated on an urgent basis, the condition may give rise to life-threatening consequences. Organ damage is another acute complication of the disease. The vital organs of the body, such as the kidneys or the liver, could be damaged due to the inability of the heart to pump enough oxygen-rich blood to the remaining areas of the body. Damage to the kidneys or the liver can make the condition deteriorate further. This is due to the fact that the kidneys secrete chemicals that keep the muscles functioning while the liver secretes proteins which aid in blood coagulation or clotting. The damage can be permanent based on the duration that you are in the state of shock. It is due to this reason that urgent medical treatment is needed for remedying this condition.

In worst cases, the condition may also lead to brain damage which can result in the death of sufferers.

Cardiogenic shock Risk Factors

The susceptibility to this condition is greater in some heart attack patients than others. Certain factors, which increase the risk of having this problem, are:

• Having a history of heart attack or heart failure
• Being 65 years of age or over
• Being a diabetic
• Having obstructions in a number of the main arteries of the heart (Coronary Artery Disease)

Cardiogenic shock Prognosis

Although rare, the condition is often found to become life-threatening if not cured on an immediate basis. The prognosis is very poor in the absence of timely treatment. Unless treated in time, only half of all people suffering from Cardiogenic shock are seen to survive. In the past, around 80-90% people affected with this disorder suffered death. With greater understanding of the disease and improvement in medical treatment, the mortality rate has dropped to around 50-75%.

Cardiogenic shock Prevention

One can prevent the occurrence of this condition by preventing heart attack itself. This can be done by making a few lifestyle changes, which include:

Not smoking

Reducing smoking or giving up the habit altogether can significantly reduce the risk of heart attack by allowing normal supply of oxygen to the heart. A few years after quitting the habit, the risk of stroke is found to be the same for a former smoker as a non-smoker.

Working out regularly

Regular exercise can reduce the risk of heart attack by improving the health of the heart and the blood vessels. Working out can also raise the level of HDL (high-density cholesterol) and lower the blood pressure. It also helps manage diabetes, lower stress and lose weight – thus improving overall health and lowering the risk of heart problems.

Lowering saturated fat and cholesterol

Eating less of foods that are high in cholesterol and fat, particularly saturated fat, is also believed to lower the risk of heart problems by reducing body fat. Doctors might recommend a drug to lower cholesterol artificially if patients find it difficult to manage the level only through dietary changes.

If you or anyone in your family is experiencing the symptoms of Cardiogenic shock, seek medical attention on an urgent basis. This is a medical emergency and should be treated as one. Call your local emergency number, such as 911, or contact your nearest medical care facility to avail immediate treatment. If treated on time, you can recover from this condition just like any other disorder and evade any possible fatal complications.

References:

http://www.mayoclinic.com/health/cardiogenic-shock/DS01152

http://emedicine.medscape.com/article/152191-overview

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001237/