7 cardiogenic shock concept mechanism of development. Cardiogenic shock is a complication of myocardial infarction

Heart pathologies vascular system occupy first place in terms of mortality rate among the population. At severe course heart failure or complicated myocardial infarction, patients are at risk of developing such a critical condition as cardiogenic shock, which in 70–85% leads to death. What is cardiogenic shock, what are its symptoms and how to treat first first aid with cardiogenic shock?

What is cardiogenic shock?

Cardiogenic shock – critical condition organism in which it is noted a sharp decline Blood pressure with subsequent deterioration of blood circulation in all internal organs and systems. The danger of cardiogenic shock lies in the fact that during its development the rheological property blood, its viscosity increases, microthrombi form in the body. With cardiogenic shock, a reduction in heart rhythm occurs, which entails the development of disorders in the whole body. All vital organs stop receiving oxygen, as a result hypoxia develops: necrosis of the liver, kidneys, metabolic processes are disrupted, and work deteriorates nervous system and the whole organism. Despite advances in modern cardiology and medicine, patients who develop symptoms of cardiogenic shock can be saved only in 10% of cases.

Types of cardiogenic shock

In medicine, there are three main types of cardiogenic shock, each of which has its own degree of severity and causes of development:

Reflex – light form cardiogenic shock, in which extensive myocardial damage occurs. Decline blood pressure occurs against the background of severe pain in the chest area. Timely rendered health care will help relieve symptoms and improve the prognosis for further treatment.
Arrhythmic shock is the result of acute bradyarrhythmia. With timely administration antiarrhythmic drugs, defibrillator use acute period can be bypassed.
Areactive shock - can manifest itself with repeated myocardial infarction, when there is no positive reaction to drug therapy. In development of this disease are happening irreversible changes in tissues with 100% fatal.

Regardless of the type of cardiogenic shock and its severity, the pathogenesis is practically no different: a sharp decrease in blood pressure, severe oxygen hypoxia internal organs and systems.

Signs and symptoms of cardiogenic shock

The clinical picture of cardiogenic shock is pronounced, develops over several hours and is characterized by:

A sharp drop in blood pressure.
Changes appearance large: sharp and panicky facial features, pale skin.
Speaking cold sweat.
Breathing, rapid.
Weak pulse.
Loss of consciousness.

With the development of cardiogenic shock, the blood supply to the brain is disrupted, and as a result, if assistance is not provided to the patient in a timely manner, the mortality rate is 100%. The only way to save a person or increase the chances of life before the ambulance team arrives - to provide first aid to the patient. Of course, if cardiogenic shock develops in a hospital setting, the patient has a better chance of life, since doctors will be able to quickly provide emergency assistance with cardiogenic shock.

First aid for cardiogenic shock

Help for a patient with cardiogenic shock should be provided by any person who is nearby. It is very important to “remove” panic, gather your thoughts and realize that a person’s life depends on your actions. The emergency care algorithm for cardiogenic shock, before the arrival of the resuscitation team, consists of the following actions:

Place the patient on his back.
Call a team of doctors, and clearly describe to the dispatcher the person’s symptoms and his condition.
To increase blood flow to the heart, you can slightly raise your legs.
Provide free air to the patient, unbutton your shirt, open the windows.
Measure blood pressure.
If necessary, when the patient has lost consciousness, perform cardiopulmonary resuscitation.
After the doctors arrive, tell them what actions you took and all other information about the person’s health, of course, if it is familiar to you.

If a person does not have medical education or does not know what medications are allowed for a particular patient, there is no point in giving heart drops or nitroglycerin, and painkillers or medications for hypertension can harm the patient even more. Even if a person knows the algorithm for cardiogenic shock and can provide all necessary help patient, there is no 100% guarantee that the patient will live, especially with severe forms critical condition.

If the patient's condition is critical, he cannot be transported. Medical workers must carry out all emergency procedures on site. Only after the pressure has stabilized can the patient be hospitalized in the department intensive care where he will be provided further assistance. It is very difficult to give a prognosis for cardiogenic shock; it all depends on the degree of damage to the heart and internal organs, as well as the age of the patient and other characteristics of his body.

Cardiogenic shock is the worst degree acute failure blood circulation when the heart stops performing its main function to supply all organs and systems with blood. Most often, this complication develops with acute widespread myocardial infarction in the first or second day of the disease.

Conditions for the development of cardiogenic shock can arise in patients with defects, during operations on large vessels and the heart. Despite the achievements modern medicine, the mortality rate for this pathology remains up to 90%.

Causes

The causes of cardiogenic shock occur inside the heart or in the surrounding vessels and membranes.

TO internal reasons relate:

Acute myocardial infarction of the left ventricle, which is accompanied by a long-term uncontrolled pain syndrome, development of severe weakness of the heart muscle due to a large area of necrosis. The spread of the ischemic zone to the right ventricle significantly aggravates the shock.
Paroxysmal types of arrhythmias with high pulse frequency during fibrillation and ventricular fibrillation.
due to the inability to conduct impulses from the sinus node to the ventricles.

External causes are considered:

Various inflammatory or traumatic injuries pericardial sac (the cavity in which the heart lies). As a result, an accumulation of blood (hemopericardium) or inflammatory exudate occurs, compressing the outside of the heart muscle. Under such conditions, reductions become impossible.
Pneumothorax (air in pleural cavity due to lung rupture).
Development of large trunk thromboembolism pulmonary artery disrupts blood circulation through the pulmonary circle, blocks the functioning of the right ventricle, and leads to tissue oxygen deficiency.

Mechanisms of pathology development

The pathogenesis of the appearance of hemodynamic disturbances differs depending on the form of shock. There are 4 varieties.

Reflex shock- caused by the body's reaction to severe pain. In this case, there is a sharp increase in the synthesis of catecholamines (substances similar to adrenaline). They cause spasm peripheral vessels, significantly increase resistance to heart function. Blood accumulates at the periphery, but does not nourish the heart itself. The energy reserves of the myocardium are quickly depleted, and acute weakness develops. This variant of the pathology can occur with a small area of infarction. Is different good results treatment if pain is relieved quickly.
Cardiogenic shock (true)- associated with damage to half or more muscle mass hearts. If even part of a muscle is excluded from work, this reduces the strength and volume of blood ejection. With significant damage, the blood coming from the left ventricle is not enough to nourish the brain. She doesn't go to coronary arteries, the supply of oxygen to the heart is disrupted, which further impairs the ability of myocardial contraction. The most severe variant of the pathology. Reacts poorly to therapy.
Arrhythmic form- impaired hemodynamics is caused by fibrillation or rare contractions of the heart. Timely use of antiarrhythmic drugs, the use of defibrillation and electrical stimulation allows one to cope with such pathology.
Areactive shock - most often occurs with repeated heart attacks. The name refers to the body's lack of response to therapy. In this form, hemodynamic disturbances are accompanied by irreversible tissue changes, accumulation of acid residues, and slagging of the body with waste substances. With this form, death occurs in 100% of cases.

Depending on the severity of shock, all described mechanisms take part in the pathogenesis. The result of the pathology is a sharp decrease contractility hearts and pronounced oxygen deficiency internal organs, brain.

Clinical manifestations

Symptoms of cardiogenic shock indicate the manifestation of impaired blood circulation:

the skin is pale, the face and lips have a grayish or bluish tint;
cold, sticky sweat is released;
hands and feet are cold to the touch;
varying degrees of impairment of consciousness (from lethargy to coma).

When measuring blood pressure, low numbers are revealed (the upper one is below 90 mm Hg), the typical difference with the lower pressure is less than 20 mm Hg. Art. Pulse on radial artery not detectable, difficult to detect when sleepy.

When pressure drops and vasospasm occurs, oliguria (low urine output) occurs, leading to complete anuria.

The ambulance is required to deliver the patient to the hospital as quickly as possible after providing assistance.

Classification

Classification of cardiogenic shock according to the severity of the patient’s condition involves three forms:

Clinical manifestations	1st degree (light)	2nd degree (moderate)	3rd degree (heavy)
Duration of shock	less than 5 hours	from 5 to 8 hours	more than 8 hours
Blood pressure in mm Hg. Art.	at the lower limit of normal 90/60 or up to 60/40	upper at 80-40, lower at 50-20	not defined
Tachycardia (beats per minute)	100–110	up to 120	dull tones, threadlike pulse
Typical symptoms	weakly expressed	left ventricular failure predominates, pulmonary edema is possible	pulmonary edema
Response to treatment	good	slow and unstable	absent or short-term

Diagnostics

Diagnosis of cardiogenic shock is based on typical clinical signs. Much harder to determine the real reason shock. This must be done to clarify the regimen of upcoming therapy.

At home, the cardiology team performs an ECG examination and determines the signs acute heart attack, a type of arrhythmia or blockade.

In a hospital setting, ultrasound of the heart is performed according to emergency indications. The method allows us to detect a decrease contractile function ventricles.

An X-ray of the chest organs can reveal altered contours of the heart due to defects and pulmonary edema.

As treatment progresses, doctors in the intensive care or resuscitation room check the degree of oxygen saturation of the blood, the functioning of internal organs using general and biochemical tests, and take into account the amount of urine excreted.

How to provide first aid to a patient

Help for cardiogenic shock from loved ones or passers-by may include: call as soon as possible"Ambulance", full description symptoms (pain, shortness of breath, state of consciousness). The dispatcher can send a specialized cardiology team.

Laying the patient down with his legs elevated is necessary to improve blood supply to the brain

As first aid, you should remove or untie your tie, unfasten your tight collar, belt, and give Nitroglycerin for heart pain.

Goals of first aid:

elimination of pain syndrome;
maintaining blood pressure with medications at least at the level lower limit norms.

To do this, the ambulance administers intravenously:

painkillers from the group of nitrates or narcotic analgesics;
drugs from the group of adrenergic agonists are used carefully to increase blood pressure;
with sufficient pressure and pulmonary edema fast-acting diuretics are needed;
oxygen is given from a cylinder or pillow.

The patient is urgently taken to the hospital.

Treatment

Treatment of cardiogenic shock in the hospital continues the therapy started at home.

In case of fibrillation, an electrical discharge is performed urgently with a defibrillator.

The algorithm of actions of doctors depends on a quick assessment of the vital work important organs.

Insertion of a catheter into the subclavian vein for infusion therapy.
Determination of the pathogenetic factors of the state of shock - the use of painkillers when pain continues, antiarrhythmic drugs in the presence of a disturbed rhythm, elimination of tension pneumothorax, .
Lack of consciousness and own breathing movements- intubation and transition to artificial ventilation lungs using breathing apparatus. Correction of oxygen content in the blood by adding it to the breathing mixture.
When receiving information about the onset of tissue acidosis, add sodium bicarbonate solution to the therapy.
Installation of a catheter in bladder to control the amount of urine excreted.
Continuation of therapy aimed at increasing blood pressure. To do this, Norepinephrine, Dopamine with Reopoliglucin, and Hydrocortisone are carefully administered by drip.
The administered fluid is monitored; when pulmonary edema begins, it is limited.
To restore the impaired coagulating properties of blood, Heparin is added.
Lack of response to the applied therapy requires an urgent solution to the operation of intra-aortic counterpulsation by introducing a balloon into the descending aortic arch.

The method allows you to maintain blood circulation before performing coronary angioplasty, inserting a stent, or deciding whether to perform coronary artery bypass grafting for health reasons.

The only way that helps areactive shock, may become an emergency heart transplant. Unfortunately, the current state of healthcare development is still far from this stage.

International symposiums and conferences are devoted to the organization of emergency care. Government officials are being asked to increase spending to bring cardiac specialty care closer to the patient. Early start treatment plays vital role in preserving the life of the patient.

Cardiogenic shock is characterized by a sudden disruption of the heart. Since this is the main pump of human life, this situation entails serious consequences because significant heart damage occurs.

This leads to cessation of blood circulation, due to which vital organs such as the brain and kidneys do not receive the necessary nutrients.

The vessels lose their tone, therefore, in turn, they are not able to deliver oxygen and blood to these organs and even to the heart itself. This is only a superficial consideration of simple but important functions, which stop working as they should, but in reality everything happens much more complicated, so the consequences are not long in coming.

If we consider normal work our internal pump, then in one contraction it pushes out a certain amount of blood, which is described as stroke volume. The heart contracts on average 70 times per minute, that is, it pumps the minute volume. Thus, we can describe the main indicators of the pumping function of the heart muscle. Now is the time to understand what happens during certain disorders, that is, to see what the pathogenesis of cardiogenic shock is.

Causes

The thing is that any catastrophe that occurs in our body leads to a sharply increased need for oxygen, the lack of which can be compensated for by increased heart contraction, higher blood pressure and rapid breathing. If an imbalance occurs and the heart or blood vessels are unable to cope with it, then stroke volume, cardiac output, or blood pressure drops. This happens because it is broken important system hearts.

It is important to remember that the heart has its own conduction system, a complete blockage of which leads to the cessation of heart function. The rhythm of excitation is disrupted, or impulses, so the cells are excited out of their rhythm, which can be described as arrhythmia.

Damage to the heart itself contributes to the disruption of full muscle contraction, and this occurs due to impaired nutrition of the heart cells or necrosis. The more necrosis, the more likely development of shock.

If the closure of the artery occurs gradually, shock may also occur with a delay. It is also important to understand that when the heart muscle ruptures, the contraction of the heart is greatly impaired. We can conclude that cardiogenic shock is a consequence of necrosis of 40% of the LV myocardium, which, by the way, is rarely compatible with life.

Role various mechanisms, responsible for the development of cardiogenic shock during MI

This big picture, allowing you to understand why and how the heart’s work goes wrong. It can be seen that all processes are interconnected and disruption of one of them can lead to shock, so there are other causes of cardiogenic shock, let’s look at some.

Myocarditis, that is, inflammation of cardiomyocytes.
Accumulation of fluid in the heart sac. Between the pericardium and myocardium there is a small space containing a certain amount of fluid, thanks to which the heart moves freely, that is, without much friction. With pericarditis, this fluid increases, and a sharp increase in volume leads to tamponade.
Pulmonary embolism. The flying thrombus clogs the artery of the lungs, which leads to blockage of the right heart ventricle.

Symptoms

The classification of cardiogenic shock includes five forms of this condition:

Arrhythmic shock. Arterial hypotension develops due to low cardiac output, there is a connection with tachy- or bradyarrhythmia. There is a predominant tachysystolic and bradysystolic form of arrhythmic shock.
Reflex shock. It is characterized by strong painful sensations. Pressure drops due to reflex influence affected area of the heart muscle. This form is easy to stop in effective ways, so some experts do not classify it as cardiogenic shock.
True cardiogenic shock. This form is 100% fatal, because the development mechanisms lead to irreversible damage that are incompatible with life.
Shock due to myocardial rupture. In this case, a reflex drop in blood pressure and cardiac tamponade occurs. There is also overload of the left heart chambers and a decrease in myocardial contractile function.
Areactive shock. This is analog true shock However, there are differences in the greater severity of pathogenetic factors, so the course is especially severe.

In this regard, the clinic of cardiogenic shock is presented as follows:

decrease in blood pressure below 80 mm Hg. Art., and if a person suffers from arterial hypertension, then below 90;
oliguria;
dyspnea;
loss of consciousness;
pallor.

The severity of a patient's condition can be determined by its duration and the person's response to pressor amines. If cardiogenic shock lasts more than five hours and cannot be stopped medicines, and also arrhythmia and pulmonary edema are observed, and areactive shock occurs.

However, it is important to understand that lowering blood pressure is relatively late sign. Decreases first cardiac output, then a reflex develops sinus tachycardia and pulse blood pressure decreases. At the same time, vasoconstriction of blood vessels in the skin, kidneys and brain develops.

Vasoconstriction may help maintain acceptable blood pressure levels. There will be a progressive deterioration in the perfusion of tissues and organs, and, of course, the myocardium. Against the background of severe vasoconstriction, it is determined by auscultation noticeable decrease Blood pressure, although intra-arterial pressure, which is determined by arterial puncture, remains normal.

This means that if invasive pressure control cannot be carried out, it is best to palpate the large arteries, that is, the femoral and carotid, as they are not so susceptible to vasoconstriction.

Diagnostics

It is very easy to identify cardiogenic shock, as this is done on a clinical basis. Considering the severity of the patient’s condition, the doctor simply does not have time to examine him in detail, so the diagnosis is based on objective data.

The skin color is marbled, pale, observed.
Reduced body temperature.
Cold, sticky sweat.
Difficulty, shallow breathing.
The pulse is frequent, thread-like, difficult to palpate, tachyarrhythmia, bradyarrhythmia.
Muffled heart sounds.
Sharply reduced systolic blood pressure, diastolic blood pressure may be less than 20.
MI on ECG.
Decreased diuresis or anuria.
Pain in the heart area.

Quick diagnosis allows you to take the necessary measures in a timely manner

However, it is important to understand that cardiogenic shock manifests itself in different ways; we have listed only the most common symptoms. Such diagnostic studies, like an ECG, coagulogram, ultrasound, and so on, are necessary in order to understand how to proceed further. They are carried out in a hospital setting, if the ambulance team managed to transport the patient to the hospital.

Treatment

Treatment of cardiogenic shock is primarily based on emergency care, so anyone should be familiar with the symptoms of this condition and know how to proceed. It cannot be confused with, for example, alcohol intoxication, such a turmoil can cost lives.

Myocardial infarction and subsequent shock can occur anywhere. We sometimes see a person lying on the street who may need resuscitation. Let's not pass by, because a person may be a few minutes from death.

So, if there are signs clinical death, it is necessary to immediately begin resuscitation efforts. You must also immediately call ambulance, another person can do this so as not to waste time.

Emergency care includes artificial respiration And indirect massage hearts. Take the time to explore how it's done and even practice with someone.

However, anyone can call an ambulance. In this case, the dispatcher needs to describe all the symptoms that are observed in the person.

The algorithm of action of ambulance specialists depends on how cardiogenic shock proceeds, but resuscitation measures begin immediately, that is, in the intensive care unit itself.

The patient's legs are elevated at an angle of 15 degrees.
They supply it with oxygen.
The trachea is intubated if the patient is unconscious.
Start infusion therapy if there are no contraindications such as pulmonary edema and swelling of the neck veins. This therapy is based on the use of a solution of rheopolyglucin, prednisolone, thrombolytics and anticoagulants.
Vasopressors are administered to maintain blood pressure at least at a minimum level.
They stop an attack if the rhythm is disturbed. For tachyarrhythmia, electrical pulse therapy is performed; for bradyarrhythmia, accelerating cardiac pacing is used.
Defibrillation and VF are used.
Perform indirect cardiac massage if cardiac activity stops.

Cardiogenic shock is treated not only depending on the pathogenesis, but also on the basis of symptoms. For example, if pulmonary edema is observed, diuretics, nitroglycerin, adequate pain relief are used, and alcohol is also administered. If severe pain is observed, promedol and other drugs are used.

Consequences

Even if cardiogenic shock did not last long, complications such as pulmonary infarction, rhythm disturbances, skin necrosis, and so on can rapidly develop. The condition may be of moderate severity, but mild degree there is no such thing. Even the average severity of the condition does not allow us to talk about good prognosis. Even if the body responds well to treatment, this can quickly give way to a worse picture.

Severe shock does not allow us to talk about survival. Unfortunately, in this case the patient does not respond to treatment, so about 70% of patients die in the first 24 hours, mostly within six hours. The rest die after two or three days. Only 10 people out of 100 can overcome this condition and survive, but many of them subsequently die from heart failure.

In this regard, it becomes clear how necessary it is to carefully monitor your health, starting from childhood, however, it is never too late to change your lifestyle and start all over again!

One of the most dangerous diseases is cardiogenic shock, the symptoms of which cannot always be recognized in time. This leads to the patient dying suddenly, since they do not have time to provide him with emergency assistance, not to mention treatment. To recognize the first signs of this terrible disease, it is necessary to become familiar with the course of the disease and the characteristics of the symptoms of shock.

Symptoms of cardiogenic shock

The main signs of cardiogenic shock are characteristically expressed, they are difficult to confuse with others, especially when the person has previously had heart problems. The sequence of all changes in the body during such a disease, i.e., the mechanism of cardiogenic shock, can be roughly represented as follows:

Systolic output is greatly reduced, and a cascade of compensatory and adaptive mechanisms is observed.
A generalized narrowing of arterial and venous vessels occurs.
A generalized spasm of arterioles is observed, as a result of which peripheral resistance appears and centralization of blood flow.
The volume of circulating blood increases, this puts additional serious stress on the heart muscle and on the left stomach, which the organ can no longer cope with.
The development of cardiac left ventricular failure appears, diastolic pressure rises.
The microcirculation pool undergoes severe disturbances.

The symptoms of cardiogenic shock do not end there. The following processes are possible:

depletion of the capillary bed;
the appearance of metabolic acidosis;
decreased blood filling of the coronary arteries;
necrobiotic, dystrophic, necrotic phenomena in organs, tissues (usually the liver, kidneys, skin);
increase in hematocrit level, i.e. the relationship between red blood and blood plasma;
increasing capillary permeability.

All these disorders cause the appearance of individual foci of ischemia. The plasma output gradually decreases. The process is developing rapidly, it is difficult to stop it in time. Gradually, the disturbances affect the entire body, the process spreads like a fire. Edema forms in the lungs, as well as in the brain area. Multiple foci of internal hemorrhages appear.

This development mechanism ultimately leads to the death of the patient, since the course is rapid, and it is almost impossible to determine the symptoms in time. It often happens that a relatively healthy outwardly person simply falls on the street and dies within a few hours, no help helps him. This is complicated by the fact that most passers-by simply do not notice, thinking that the patient is drunk.

Diagnosis of cardiogenic shock

The peculiarity of diagnostics is that the doctor does not have much time to make a correct diagnosis. Therefore, the so-called primary signs, i.e. objective data. Among them it is necessary to highlight:

a decrease in body temperature, along with the appearance of sticky cold sweat;
cyanosis, so-called marble leather, too much paleness;
difficult, superficial or rapid breathing, especially against the background of a drop in blood pressure;
rapid pulse, tachycardia, low filling, thread-like pulse or cannot be felt at all;
systolic pressure is greatly reduced, does not increase from 60 mm Hg. Art. often not determined at all;
when taking an ECG, a picture of MI is observed;
the tones are muffled, it is rarely possible to listen to the protodiastolic rhythm, III tone;
renal function is impaired, anuria and decreased diuresis appear;
There is pain in the heart area.

Symptoms may vary from patient to patient, so diagnosis can only be made by experienced doctor. Additionally, ultrasound, ECG and other diagnostics may be prescribed, which will help to see the picture of the disease in a more expanded manner. The measures do not take much time, but they are often carried out against the backdrop of therapeutic measures, since even a minute of delay can cost the patient his life. If possible, some types of studies are performed directly in the ambulance on the way to the hospital.

First aid for cardiogenic shock

Getting to the clinic with such a condition as cardiac shock, it doesn’t always work out on time. That is why close attention must be paid to first aid. For it to be effective, you need to have a good understanding of the symptoms. It is important to remember that cardiogenic shock can occur anywhere and at any time. Many people make the mistake of mistaking a person who has fallen on the street for a drunk. In fact, his life could have been saved if not for the indifference and delusions of those around him. Yours Negative influence Ignorance of the basics of first aid for heart diseases also contributes, because even correctly performed artificial respiration and cardiac massage could save a life.

What you need to know about first aid? Initially, you need to pay attention to the following signs:

sticky cold sweat covering the skin;
pale complexion, almost bluish;
hypothermia, i.e. a sharp decrease in body temperature;
lack of reaction to surrounding events;
your blood pressure drops significantly (usually only a health care professional or someone with a portable blood pressure measuring device can detect this).

In case of cardiogenic shock, it is necessary to perform the following set of actions:

A person's legs are raised approximately 15 degrees upward.
The patient needs to ensure a flow of fresh air, for which he receives oxygen (in the intensive care unit) or he needs to open the windows, unbutton too tight collars, and ensure the flow of oxygen.
When the patient is unconscious, tracheal intubation is required to ensure the necessary breathing.
Already carried out in hospital settings special measures, for example, if there are no contraindications, drugs such as prednisolone, thrombolytics, anticoagulants are administered (contraindications are pulmonary edema, swelling of the veins in the neck).
Vasopressors are administered to maintain blood pressure at least at a minimum level.
Arrhythmia requires relief. For tachycardia, electric pulse therapy is used, for bradyarthria, special accelerating cardiac pacing is used, and for fibrillation, ventricular defibrillation is used. If there is asystole, indirect massage is performed.

Forecasts for the development of the disease

Even Clinical signs were recognized in time, the prognosis for this disease is not the best.

If the shock is short-lived and general state managed to stabilize, thrombosis develops against its background large vessels, infarctions of organs such as the spleen, lungs, skin necrosis, hemorrhages.

Much depends on how much the blood pressure has dropped and what the signs of disorders are. peripheral systems, general reaction body for treatment. There's no such thing as mild degree cardiogenic shock, such a disease is always serious. Many doctors advise against deluding yourself too much about the diagnosis of moderate severity, since the condition is also complex. It is important to ensure that it does not develop side effects, the condition did not begin to deteriorate. That is why it is recommended that the patient spend time under constant supervision.

The severe form, the manifestations of which are more serious, leaves almost no chance of survival, even if emergency assistance is provided in time. The vast majority of patients, approximately 70%, die within the first 24 hours, but most often mortality occurs in the first 4-6 hours after shock. Some patients can live for a couple of days, but rarely anyone survives for more than 3 days. According to statistics, only ten patients out of a hundred manage to survive after shock, but their condition cannot be called normal or healthy. Often such patients soon die from heart failure.

There are quite a few signs of cardiogenic shock, but all of them together create a fairly characteristic picture that allows us to diagnose accurate diagnosis. Even a common person can recognize such signs and then provide prompt emergency assistance until a doctor arrives. Exactly emergency measures are vital for the salvation of man.

Cardiogenic shock is one of the most common complications of myocardial infarction, which becomes the main cause of death of the patient. It becomes clear that the pathology is very dangerous and requires immediate action. The clinical picture of cardiogenic shock is varied and depends on what causes led to similar condition.

The essence of pathology

Cardiogenic shock is a consequence of acute heart failure, which occurs if the heart ceases to perform its main function, that is, to supply blood to all vital human organs. Cardiogenic shock and its clinical manifestations usually develop almost immediately after myocardial infarction. What cardiogenic shock is, pathogenesis, classification, clinical picture and treatment will be discussed further.

Severity

Cardiogenic shock can be clinically divided into 3 degrees of severity:

In the first degree of severity, shock can last no more than 5 hours. Clinical manifestations are not pronounced. Blood pressure is slightly reduced, heart rate is slightly increased. Cardiogenic shock of the first degree is easily treatable.
An attack in the second degree can last from 5 to 10 hours, but no more. Blood pressure is greatly reduced, the pulse is rapid, and swelling of the lungs occurs; the left ventricle of the heart has difficulty coping with its duties, that is, heart failure is observed. This degree pathology responds very slowly to therapeutic measures.
State of shock with the third degree of severity it lasts more than 10 hours. The pressure is very low, the lungs are very swollen, the pulse is more than 120 beats per minute. If there is a positive reaction to resuscitation measures, it is short-lived.

Cardiogenic and clinic

Pathology with her clinical manifestations is divided into 4 main forms, depending on the severity of the pathological process:

Reflex. The mildest form of pathology, which is characterized by a drop in blood pressure. If measures to eliminate symptoms are not taken in time, then this form the disease can develop into next stage.
True. Extensive heart attack myocardium, in which the tissue of the left ventricle of the heart dies. When tissue necrosis exceeds 50%, then, despite all resuscitation measures taken, the patient dies.
Areactive. The most severe form of pathology, in which a multifactorial pathogenesis of cardiogenic shock with its clinical manifestations is observed. Areactive cardiogenic shock does not respond to any therapy and always leads to the death of the patient.
Arrhythmic. The pathology is associated with a violation heart rate, that is, with an increase or decrease in heart rate. If the patient is resuscitated in a timely manner, the condition can be normalized.

Pathogenesis of cardiogenic shock and clinical picture depending on the causes

The main reasons for the development of cardiogenic shock are:

Myocardial infarction. In this condition, the following is observed: clinical picture: stabbing pain in the sternum, panic fear death, shortness of breath and pale skin, lack of results from taking nitroglycerin.
Heart rhythm disturbances. A person develops tachycardia, arrhythmia, or bradycardia.

How to understand that shock has occurred

The sooner emergency care is provided in the clinic for cardiogenic shock, the greater the chance that the patient will survive. The clinical manifestation of cardiogenic shock always depends on what particular pathology caused its development:

In shock caused by myocardial infarction, the patient always experiences severe pain in the chest area and behind it. In most cases, after the pain, a feeling of fear of death appears, and panic begins.
If the cause of cardiogenic shock is a cardiac arrhythmia, the patient may experience tachycardia or bradycardia immediately after the onset of chest pain.
appears severe weakness, it becomes difficult for the patient to breathe, and sometimes coughing up blood may appear. Skin on the patient's head, neck and chest become sallow or gray in color.

Signs of cardiogenic shock

Regardless of the reasons, but varying degrees appear following symptoms cardiogenic shock, which are the result of low blood pressure: the patient begins to sweat heavily, the lips and nose take on a blue tint, the veins in the neck swell greatly, the arms and legs become cold.

If the patient does not receive urgent medical care at the time of cardiogenic shock, he will first lose consciousness as the cardiac and brain activity and then dies.

Diagnosis of cardiogenic shock

To diagnose cardiogenic shock, the clinic carries out the following activities:

Electrocardiogram.
Ultrasonography hearts.
X-ray of the chest organs.
Biochemical analysis blood and urine, which is carried out throughout the course of treatment.

First aid for cardiogenic shock

The first thing to do in a cardiogenic shock clinic is to call an ambulance. And before her arrival, it is necessary to sit the patient down, free the neck from everything unnecessary and chest, give him a nitroglycerin tablet under the tongue.

Upon arrival of emergency doctors, the following activities are carried out:

To alleviate the patient's condition and eliminate pain, painkillers are used, which are mainly classified as narcotic medications. This is "Promedol", "Fentanyl".
To increase blood pressure, drugs such as Dopamine and Norepinephrine can be used.
The patient undergoes drip administration saline solution and glucose.
Prednisolone is used.
Panangin helps normalize the pulse.
If necessary, defibrillation or chest compressions are performed.
In order to eliminate pulmonary edema, diuretics are prescribed, in particular Furosemide.
To prevent thrombosis, the patient is given Heparin.
In order to improve the functioning of the body's metabolic processes, the patient is injected with a solution of sodium bicarbonate.
Oxygen inhalations are used to normalize oxygen levels in the body.

All of the above activities are carried out in an ambulance on the way of the patient to the hospital.

Therapeutic measures

Upon admission of the patient to the hospital, full examination in order to determine the clinic of cardiogenic shock and treatment. Further therapy is carried out based on what served as the impetus for development.

Since the main cause of cardiogenic shock is myocardial infarction, the patient is given thrombolytic therapy to eliminate the “clog” in the coronary artery. If the patient is in a coma, then tracheal intubation is performed. This procedure helps maintain the patient's breathing even in an unconscious state.

If the condition of a patient with cardiogenic shock and its clinical manifestations does not improve after drug therapy, then the doctor may decide to perform an emergency surgical intervention in order to save the patient's life.

The following methods are used to combat the clinical manifestations of cardiogenic shock: surgical interventions:

Coronary artery bypass grafting. The procedure consists of creating an additional bloodstream, which is a bridge, used before the myocardial transplantation is performed.
Percutaneous transluminal coronary angioplasty. This operation implies full recovery integrity blood vessels, ensuring the normalization of the contractile function of the heart muscle.

Survival prognosis

If in case of cardiogenic shock of the first degree and its clinic was provided timely assistance, and the patient was immediately taken to the hospital, then we can say that the patient will survive. With the second and third degrees of cardiogenic shock, mortality occurs in 70-80% of cases.

Preventive measures

If the patient is diagnosed with cardiogenic shock, then no preventive measures there is no way to help him, so it is important to take care of his health and prevent the development of any pathological processes. Disease Prevention of cardio-vascular system- This:

Refusal bad habits. If a person often smokes and abuses alcohol, and his nutrition leaves much to be desired, then sooner or later the body will begin to malfunction. As a result of poor-quality nutrition, smoking and alcohol consumption, blood vessels begin to form on the walls of blood vessels. atherosclerotic plaques, due to which the load on the heart increases significantly and, as a result, the functioning of all vital organs of the body deteriorates.
Monitoring the level of physical activity. It is important that everything physical exercise on the body were regular and uniform. So, excessive loads can cause enormous harm to the body, while sedentary lifestyle life affects him just as detrimentally, so it is necessary to maintain a balance, that is physical activity need to alternate with rest. If it is not possible to engage in any kind of sport, then you need to do daily hiking on fresh air, swim, ride a bike. You need to sleep at least eight hours a day, this time is enough to effectively rest after working day.
Preventive examination. People with hereditary factors or those who are susceptible to the development of diseases of the cardiovascular system, need to be examined every six months by the attending physician with all tests necessary tests. This will help to detect the disease in time and prevent its development. serious pathologies.
Stress and emotional stress. It is very important to remember that during stressful situations or emotional stress, the level of the hormone adrenaline increases sharply, which adversely affects the functioning of the cardiovascular system, so it is very important to treat any life situation, this is the only way to achieve what the heart long years will work without deviations.
Healthy eating. The patient's diet should contain required amount useful macro- and microelements. For this it is important to adhere to a special diet.

The pathogenesis, clinical picture and treatment of cardiogenic shock have now become clear. Heart disease is often fraught with death for the patient, so it is very important to follow all of the above recommendations and, at the slightest suspicion of any pathology, immediately seek the help of specialists.