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An extreme degree of left ventricular failure, characterized by inadequate blood supply to internal organs with subsequent disruption of their functions. A sharp deterioration in the blood supply to organs and tissues during cardiogenic shock is associated with a number of factors, the most important of which are:

• decreased cardiac output;
• narrowing of peripheral arteries;
• decrease in circulating blood volume (CBV);
• opening of arteriovenous shunts;
• disruption of capillary blood flow as a result of intravascular coagulation.

Currently, the classification of cardiogenic shock proposed by E.I. is generally accepted. Chazov (1969), according to which four of its forms are distinguished: true, reflex, arrhythmic, areactive.

True cardiogenic shock

True cardiogenic shock is based on the death of a significant mass of the left ventricular myocardium. In most patients, significant stenosis of the lumen of the three main coronary arteries, including the anterior descending coronary artery, is determined. Almost all patients have thrombotic coronary occlusion (Antman, Braunwald, 2001).

The clinical picture of true cardiogenic shock reflects a pronounced disorder of the blood supply to internal organs, mainly vital ones ( brain , kidneys , liver, myocardium), as well as symptoms of peripheral circulatory disorders, including in the microcirculatory system. The general condition of the patient is severe, he is lethargic, loss of consciousness is possible; Short-term excitation is less common.

The main difficulty in treating cardiogenic shock of this type lies in its pathogenesis - 40% or more of the left ventricular myocardium died. Make the remaining 60% of living tissue work in double load mode, provided that hypoxia, an inevitable companion to any state of shock, itself serves as a powerful stimulator of the heart, a task that has not yet been fully solved.

Reflex cardiogenic shock

Reflex shock is based on a pain syndrome, the intensity of which may not be related to the extent of myocardial damage. This type of shock can be complicated by a disorder of vascular tone, which is accompanied by the formation of a deficit in circulating blood volume.

One of the components of the pathogenesis of reflex cardiogenic shock is a violation of vascular tone with increased capillary permeability and leakage of plasma from the vascular bed into the interstitial tissue. This causes a decrease in blood volume and blood flow from the periphery to the heart with a corresponding decrease in cardiac output (MCV). That is, a shock with a volume deficit is actually formed. It will be characterized by a combined decrease in central venous pressure (CVP), bcc, stroke volume (SV) and MOS. This variant of the pathology can increase bradycardia, especially characteristic of the posterior localization of acute myocardial infarction (AMI), which contributes to an even greater decrease in MVR and a further decrease in blood pressure (BP).

Reflex cardiogenic shock is quite easily corrected with the use of painkillers, vascular agents and infusion therapy.

Arrhythmic cardiogenic shock

The development of the arrhythmic form of cardiogenic shock is associated with rhythm and conduction disturbances, which causes a decrease in blood pressure and the appearance of signs of shock. Arrhythmic shock can be caused by ventricular tachycardia, paroxysmal tachyarrhythmias, atrioventricular block, sinoatrial block, sick sinus syndrome. Treatment of cardiac arrhythmias usually relieves signs of shock.

Areactive cardiogenic shock

Areactive shock can develop even against the background of relatively small damage to the left ventricular myocardium. It is based on a violation of myocardial contractility caused by impaired microcirculation, gas exchange, and the addition of disseminated intravascular coagulation syndrome.

A characteristic feature of areactive shock is the lack of response to the administration of pressor amines. This is due to the effect of drugs only on the remaining 50-60% of the mass of the left ventricle, the occurrence of paradoxical pulsation of the myocardium (the affected part of it does not contract during systole, but bulges), as well as an increase in the oxygen demand of the remaining part of the myocardium (due to an increase in the load on maintaining MOS at a physiological level), which contributes to an increase in the ischemic zone. In case of areactive shock in response to the administration of vasoactive drugs, a slight increase in blood pressure is accompanied by the occurrence or increase of pulmonary edema.

Sources:
1. Okorokov A.N. / Diagnosis of diseases of internal organs: T.6. Diagnosis of heart and vascular diseases // Medical literature, 2002.
2. Golub I.E. / Cardiogenic shock: Textbook // ISMU, 2011.

Cardiogenic shock is left ventricular heart failure in the acute stage. It develops within a few hours when the first signs appear, less often - in a later period. A decrease in the level of minute and stroke volume of blood cannot even be compensated by an increase in vascular resistance. As a result, blood pressure decreases and blood circulation in vital organs is disrupted.

Features of the disease

Cardiogenic shock occurs as a result of a disruption in the supply of oxygen to organs. As cardiac output decreases, perfusion to all organs decreases. Shock causes microcirculation disorders and microthrombi form. The functioning of the brain is disrupted, acute kidney and liver failure develops, trophic ulcers can form in the digestive organs, and metabolic acidosis develops due to deterioration of blood supply to the lungs.

• In adults, the body compensates for this condition by reducing systemic vascular resistance and increasing the heart rate.
• In children, this condition is compensated by an increase in heart rate and compression of blood vessels (vasoconstriction). The latter is due to the fact that it is a late sign of shock.

The classification of cardiogenic shock is discussed below.

The following video describes the pathogenesis and features of cardiogenic shock:

Forms

There are 3 types (forms) of cardiogenic shock:

• arrhythmic;
• reflex;
• true.

Arrhythmic shock occurs due to or acute bradyarrhythmia as a result of complete atrioventricular block. Functional disorders are caused by changes in heart rate. After the heart rhythm is restored, the symptoms of shock disappear.

Reflex shock is the mildest form and is caused not by damage to the heart muscle, but by a decrease in blood pressure as a result of pain after a heart attack. With timely treatment, the pressure returns to normal. Otherwise, a transition to true cardiogenic is possible.

True cardiogenic develops as a result of a sharp decrease in the functions of the left ventricle. With necrosis of 40% or more, ariative cardiogenic shock develops. Sympathomimetic amines do not help. Mortality rate is 100%.

Read below about the criteria and causes of cardiogenic shock.

Causes

Cardiogenic shock develops due to myocardial infarction, like it. Less commonly, it can occur as a complication after poisoning with cardiotoxic substances.

Immediate causes of the disease:

• heavy;
• disruption of the pumping function of the heart;
• pulmonary artery.

As a result of the shutdown of some part of the myocardium, the heart cannot fully provide blood supply to the body and the brain as well. Plus, the affected area of ​​the heart in the coronary artery increases due to reflex spasms of nearby arterial vessels.

As a result, ischemia and acidosis develop, which leads to more severe processes in the myocardium. Often the process is aggravated by asystole, respiratory arrest and death of the patient.

Symptoms

Cardiogenic shock is characterized by:

• sharp pain in the chest, radiating to the upper limbs, shoulder blades and neck;
• feeling of fear;
• confusion;
• increased heart rate;
• drop in systolic pressure to 70 mm Hg;
• sallow complexion.

If timely assistance is not provided, the patient may die.

Diagnostics

Clinical manifestations of cardiogenic shock:

• pale skin, cyanosis;
• low body temperature;
• sticky sweat;
• shallow breathing with difficulty;
• rapid pulse;
• muffled heart sounds;
• decreased diuresis or anuria;
• heartache.

The following additional examination methods are carried out:

• electrocardiogram to study focal changes in the myocardium;
• echocardiogram to assess contractility;
• anchiography to analyze the condition of blood vessels.

Treatment of cardiogenic shock during myocardial infarction is discussed below.

Treatment

Cardiogenic shock is a condition in which you should call an ambulance as soon as possible. And even better - a specialized intensive care cardiac team.

Read below about the algorithm of actions for emergency care for cardiogenic shock.

Urgent Care

First emergency care for cardiogenic shock should be carried out immediately in the following sequence:

1. put the patient down and raise his legs;
2. provide air access;
3. perform artificial respiration if there is none;
4. administer thrombolytics, anticoagulants;
5. in the absence of heart contractions, perform defibrillation;
6. perform indirect cardiac massage.

Read more about medications for cardiogenic shock.

The following video is devoted to the topic of treatment of cardiogenic shock:

Medication method

Goal of treatment: eliminate pain, increase blood pressure, normalize heart rhythm, prevent expansion of ischemic damage to the heart muscle.

• Narcotic analgesics are used. It is necessary to start drips of glucose solution intravenously, and to increase blood pressure - dosed vasoprocessor drugs (norepinephrine or dopamine), hormonal drugs.
• As soon as the pressure returns to normal, the patient should be given drugs to dilate the coronary vessels and improve microcirculation. This is sodium nitrosorbide or. Hydrocarbonate is also shown.
• If the heart has stopped, perform indirect massage, mechanical ventilation, and reintroduce norepinephrine, lidocaine, and bicarbonate. Defibrillation is performed if necessary.

It is very important to try to transport the patient to the hospital. Modern centers use the latest methods of rescue such as counterpulsation. A catheter with a balloon at the end is inserted into the aorta. During diastole, the balloon straightens; during systole, it falls. This ensures the filling of blood vessels.

Operation

Surgery is a last resort. This is percutaneous transluminal coronary angioplasty.

The procedure allows you to restore arterial patency, preserve the myocardium, and interrupt the vicious circle of cardiogenic shock. This operation should be carried out no later than 6-8 hours after the onset of a heart attack.

Prevention

Preventive measures to avoid the development of cardiogenic shock include:

• sport in moderation;
• complete and proper nutrition;
• healthy lifestyle;
• avoiding stress.

It is very important to take medications prescribed by your doctor, as well as promptly relieve pain and eliminate heart contraction disorders.

Complications of cardiogenic shock

With cardiogenic shock, the blood circulation of all organs of the body is disrupted. Signs of liver and kidney failure, trophic ulcer of the digestive organs, may develop.

Pulmonary blood flow decreases, which leads to oxygen hypoxia and increased blood acidity.

Forecast

The mortality rate for cardiogenic shock is 85-90%. Only a few make it to the hospital and recover successfully.

Even more useful information on cardiogenic shock is contained in the following video: