Cardiogenic shock: clinic, emergency care

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 pathology is very dangerous and requires immediate action. The clinic of cardiogenic shock is diverse and depends on what causes led to this condition.

The essence of pathology

Cardiogenic shock is a consequence of acute heart failure, which occurs if the heart ceases to fulfill its primary function, that is, to supply blood to all vital organs of a person. Cardiogenic shock and its clinical manifestations usually develop almost immediately after myocardial infarction. What is cardiogenic shock, pathogenesis, classification, clinic and treatment, will be highlighted below.

Severity

Clinical cardiogenic shock can be divided into 3 degrees of severity:

1. In the first degree of severity, the shock can last no more than 5 hours. Clinical manifestations are not expressed. Blood pressure is slightly reduced, the heartbeat is a little faster. Cardiogenic shock of the first degree is easily treatable.
2. An attack in the second degree can last from 5 to 10 hours, but no more. Blood pressure is greatly reduced, the pulse is frequent, and pulmonary edema occurs, the left ventricle of the heart struggles to cope with its duties, that is, heart failure is observed. This degree of pathology responds very slowly to therapeutic measures.
3. A shock condition with a third degree of severity lasts more than 10 hours. The pressure is very low, the lungs swell strongly, the pulse is more than 120 beats per minute. A positive reaction to resuscitation, if it happens, is short-lived.

Cardiogenic shock: classification and clinic

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

1. Reflex. The easiest form of pathology, which is characterized by a drop in blood pressure. If measures are not taken in time to eliminate the symptoms, then this form of the disease can go to the next stage.
2. True. Extensive myocardial infarction, in which the tissues of the left ventricle of the heart die. When tissue necrosis exceeds 50%, then, despite all the accepted resuscitation measures, the patient dies.
3. Areactive. The most severe form of pathology, in which there is a multifactorial pathogenesis of cardiogenic shock with its clinical manifestations. Areactive cardiogenic shock is not amenable to any therapy and always leads to death of the patient.
4. Arrhythmic. Pathology is associated with a violation of the heart rhythm, that is, with increased or slowed heart rate. If resuscitation of the patient is carried out in a timely manner, then the condition can be normalized.

The pathogenesis of cardiogenic shock and the clinic depending on the causes

The main reasons for the development of cardiogenic shock are:

• Myocardial infarction. In this condition, the following clinical picture is observed: stitching pain in the sternum, panic fear of death, shortness of breath and pallor of the skin, lack of result from taking nitroglycerin.
• Violation of the heart rate. A person develops tachycardia, arrhythmia, or bradycardia.
• Pulmonary embolism.

How to understand that a shock has come

The earlier emergency care is provided at the clinic of cardiogenic shock, the more likely it is that the patient will survive. The clinical manifestation of cardiogenic shock always depends on which pathology caused its development:

1. With 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, a panic begins.
2. If the cause of cardiogenic shock was a violation of the heart rhythm, then the patient immediately after the appearance of pain in the chest can begin to tachycardia or bradycardia.
3. With pulmonary embolism , sharp weakness appears, it becomes difficult for the patient to breathe, sometimes a cough with blood may appear. The skin on the head, neck and chest of the patient becomes earthy or gray.

Signs of Cardiogenic Shock

Regardless of the reasons, but to varying degrees, the following symptoms of cardiogenic shock appear, 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 on the neck swell very much, hands and feet become cold.

If the patient is not provided with urgent medical care at the time of cardiogenic shock, then he first loses consciousness, since cardiac and brain activity ceases, and then he dies.

Diagnosis of cardiogenic shock

To diagnose cardiogenic shock in the clinic, the following activities are carried out:

1. Electrocardiogram.
2. Ultrasound examination of the heart.
3. X-ray of the chest organs.
4. Biochemical analysis of blood and urine, which is carried out throughout the course of treatment.

First aid for cardiogenic shock

The first thing you need to do at a cardiogenic shock clinic is to call an ambulance. And before her arrival, it is necessary to seat the patient, release the neck and chest from all unnecessary, give him a nitroglycerin tablet under the tongue.

Upon the arrival of emergency doctors, the following events are held:

1. To alleviate the patient’s condition and eliminate pain, painkillers are used, which are mainly related to narcotic drugs. This is Promedol, Fentanyl.
2. To increase blood pressure, drugs such as "Dopamine", "Norepinephrine" can be used.
3. The patient is given a drip of saline and glucose.
4. As an antishock drug , Prednisolone is used.
5. Panangin helps to normalize the pulse.
6. If necessary, defibrillation or indirect heart massage is performed.
7. In order to eliminate pulmonary edema, diuretics are prescribed, in particular Furosemide.
8. To exclude thrombosis, the patient is injected with Heparin.
9. In order to establish the metabolic processes of the body, the patient is injected with a solution of sodium bicarbonate.
10. To normalize the level of oxygen in the body, oxygen inhalation is used.

All of the above activities are carried out in an ambulance along the path of the patient to the hospital.

Therapeutic measures

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

Since the main cause of cardiogenic shock is myocardial infarction, the patient is given thrombolytic therapy to eliminate “blockage” in the coronary artery. If the patient is in a coma, then he is intubated with a trachea. This procedure helps maintain the patient’s breathing even in an unconscious state.

If the patient’s condition with cardiogenic shock and its clinical manifestations does not improve after drug therapy, then the doctor may decide to conduct emergency surgery to save the patient’s life.

To combat the clinical manifestations of cardiogenic shock, the following surgical procedures are used:

1. Coronary artery bypass grafting. The procedure is to create an additional bloodstream, which is a bridge used before myocardial transplantation is performed.
2. Percutaneous transluminal coronary angioplasty. This operation involves the complete restoration of the integrity of blood vessels, ensuring the normalization of the contractile function of the heart muscle.

Survival forecast

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

Preventative measures

If the patient is diagnosed with "cardiogenic shock", then he can no longer help him with any preventive measures, so it is important to take care of your health and prevent the development of any pathological processes. Prevention of diseases of the cardiovascular system is:

1. Rejection of bad habits. If a person often smokes and abuses alcohol, and his diet leaves much to be desired, then sooner or later the body will begin to malfunction. As a result of poor-quality nutrition, smoking and drinking alcohol, atherosclerotic plaques begin to form on the walls of blood vessels, due to which the load on the heart increases significantly and, as a result, the work of all vital organs of the body worsens.
2. Monitoring the level of physical activity. It is important that all physical activity on the body is regular and uniform. So, excessive loads can cause tremendous harm to the body, while a sedentary lifestyle affects it just as detrimental, so you need to balance, that is, physical activity must be alternated with rest. If there is no opportunity to engage in any sport, then you need to make daily walks in the fresh air, swim, ride a bike. You need to sleep at least eight hours a day, this time is enough to effectively relax after a hard day.
3. Preventive examination. People with hereditary factors or those who are prone to the development of diseases of the cardiovascular system need to be examined every six months by their doctor with all the necessary tests. This will help to detect the disease in time and prevent the development of serious pathologies.
4. Stress and emotional stress. It is very important to remember that during stressful situations or emotional overstrain, the level of the hormone adrenaline rises sharply, which adversely affects the work of the cardiovascular system, therefore it is very important to be calm about any life situation, the only way to achieve that the heart will work for many years without deviations.
5. Healthy eating The patient’s diet should have the necessary amount of useful macro- and microelements. For this, it is important to adhere to a special diet.

Now the pathogenesis, clinical picture and treatment of cardiogenic shock became clear. Heart diseases are often fraught with death of the patient, so it is very important to follow all of the above recommendations, at the slightest suspicion of any pathology, immediately seek the help of specialists.