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

decrease in cardiac output;
narrowing of peripheral arteries;
a decrease in the volume of circulating blood (BCC);
opening of arteriovenous shunts;
violation of capillary blood flow as a result of intravascular coagulation.

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

True cardiogenic shock

The true cardiogenic shock is based on the death of a significant mass of the myocardium of the left ventricle. 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 the internal organs, mainly vital ones ( brain , kidneys , liver, myocardium), as well as symptoms of peripheral circulatory disorders, including in the microcirculation system. The general condition of the patient is severe, he is lethargic, loss of consciousness is possible; less often short-term excitation is observed.

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

Reflex cardiogenic shock

It is based on reflex shock pain syndrome, the intensity of which may not be related to the volume 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 the volume of circulating blood.

One of the components of the pathogenesis of reflex cardiogenic shock is a violation of vascular tone with an increase in capillary permeability and plasma leakage from the vascular bed into the interstitial tissue. This causes a decrease in BCC and blood flow from the periphery to the heart with a corresponding decrease in cardiac output (MOV). 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 be exacerbated by bradycardia, especially characteristic of the posterior localization of acute myocardial infarction (AMI), which contributes to an even greater decrease in MOS and a further decrease in blood pressure (BP).

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

Arrhythmic cardiogenic shock

The development of an 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. Ventricular tachycardia, paroxysmal tachyarrhythmias, atrioventricular blockade, sinoatrial blockade, sick sinus syndrome can lead to arrhythmic shock. Treatment of cardiac arrhythmias, as a rule, stops the signs of shock.

Areactive cardiogenic shock

Areactive shock can develop even against the background of a relatively small damage to the myocardium of the left ventricle. It is based on a violation of myocardial contractility caused by a violation of microcirculation, gas exchange, the addition of DIC.

Characteristic of areactive shock is the absence of a 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 myocardial pulsation (the affected part of the myocardium does not contract during systole, but swells), 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 the physiological level), which contributes to an increase in the ischemic zone. In areactive shock, in response to the introduction of vasoactive drugs, a slight increase in blood pressure is accompanied by the onset or increase in pulmonary edema.

Sources:
1. Okorokov A.N. / Diagnosis of diseases of internal organs: V.6. Diagnosis of diseases of the heart and blood vessels // Medical Literature, 2002.
2. Golub I.E. / Cardiogenic shock: Textbook // IGMU, 2011.

Cardiogenic shock is left ventricular heart failure in the acute stage. It develops in 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 is not even able to be compensated by an increase in vascular resistance. As a result, blood pressure decreases and blood circulation in vital organs is disturbed.

Features of the disease

Cardiogenic shock occurs as a result of a violation of the supply of oxygen to the organs. With a decrease in cardiac output, there is a decrease in perfusion to all organs. Shock causes microcirculation disorder, microthrombi are formed. The work of the brain is disrupted, acute kidney and liver failure develops, trophic ulcers can form in the digestive organs, due to a deterioration in blood supply to the lungs, metabolic acidosis develops.

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

The classification of cardiogenic shock is discussed below.

The following video tells about 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. Violations of the functions due to changes in the frequency of contractions of the heart. After the heart rhythm is restored, the effects 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, atrial cardiogenic shock develops. Sympathomimetic amines do not help. Lethality is 100%.

Read about the criteria and causes of cardiogenic shock below.

Causes

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

Immediate causes of the disease:

heavy;
violation of the pumping function of the heart;
pulmonary artery.

As a result of turning off 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 up to 70 mm Hg;
earthy complexion.

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

Diagnostics

Clinical manifestations of cardiogenic shock:

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

The following additional methods of examination are carried out:

electrocardiogram to study focal changes in the myocardium;
echocardiogram to assess the contractile features;
anchiography to analyze the state of blood vessels.

Treatment of cardiogenic shock in myocardial infarction is discussed below.

Treatment

Cardiogenic shock is a condition in which an ambulance should be called as soon as possible. And even better - a specialized resuscitation cardiology team.

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

Urgent care

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

put the patient down and raise his legs;
provide air access;
give artificial respiration, if there is none;
introduce thrombolytics, anticoagulants;
in the absence of heart contractions, defibrillate;
perform chest compressions.

Read more about drugs for cardiogenic shock.

The following video is about the treatment of cardiogenic shock:

Medical method

The purpose of treatment: to eliminate pain, increase blood pressure, normalize heart rate, prevent the expansion of ischemic damage to the heart muscle.

Narcotic analgesics are used. It is necessary to start dripping a glucose solution intravenously, and to increase the pressure - dosed vasoprocessor agents (norepinephrine or dopamine), hormonal drugs.
As soon as the pressure returns to normal, the patient should be given drugs to expand the coronary vessels and improve microcirculation. This is sodium nitrosorbide or. Hydrocarbonate is also shown.
If the heart has stopped, an indirect massage is performed, mechanical ventilation, norepinephrine, lidocaine, gibrocarbonate are re-introduced. If necessary, perform defibrillation.

It is very important to try to deliver the patient to the hospital. In modern centers, they use such new methods of salvation as counterpulsation. A catheter with a balloon at the end is inserted into the aorta. During diastole, the balloon expands, and during systole, it collapses. 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 the patency of the arteries, save the myocardium, break the vicious circle of cardiogenic shock. Such an 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;
avoidance of stress.

It is very important to take the medicines prescribed by the doctor, as well as timely stop the pain and eliminate the violation of heart contractions.

Complications in cardiogenic shock

With cardiogenic shock, there is a violation of the blood circulation of all organs of the body. Signs of hepatic and renal failure, a trophic ulcer of the digestive system, may develop.

Reduced pulmonary blood flow, which leads to oxygen hypoxia and increased acidity of the blood.

Forecast

Mortality in cardiogenic shock is 85-90%. Only a few make it to the hospital and recover successfully.

For more useful information on cardiogenic shock, see the following video: