Acute cardiovascular failure is a life-threatening condition. According to the development mechanism, it is divided into right- and left-ventricular OCH. Both of these conditions are often fatal. To save a person, an ambulance doctor must immediately begin resuscitation.
Most often, left ventricular heart failure occurs. It usually follows myocardial infarction, severe rhythm disturbances, and other dangerous conditions. Acne cardiogenic shock is considered a type of OSN. It is caused by severe lesions for the body, in which the heart cannot pump blood in normal mode.
The concept of cardiogenic shock
Emergency care for cardiogenic shock is necessary in the first minutes of its development. It should be remembered that this complication will not go away on its own. And in the absence of urgent treatment will lead to death. Cardiogenic shock is a syndrome in which a decrease in cardiac output occurs. Despite the compensatory increase in vascular resistance, the body can not cope with this complication without the help of doctors.
Its main manifestations include a decrease in arterial and pulse pressure, diuresis, and loss of consciousness. If help is not provided on time, death from cardiogenic shock occurs within a few hours after the development of the disease. This condition does not occur on its own. It is always preceded by acute pathologies of the cardiovascular system.
What causes cardiogenic shock?
The causes of heart shock include various cardiological and vascular diseases. The most common etiological factor is myocardial infarction. In this case, cardiogenic shock develops only with massive tissue necrosis and the absence of ambulance. Also, life-threatening arrhythmias are referred to the common causes of its occurrence. They can bother a person for many years. But with their exacerbation and decompensation, these conditions are complicated by shock.
In some cases, a violation of vascular tone is considered a factor in the development of acute heart failure. This happens with massive bleeding, pain, acute renal failure. It must be remembered that cardiogenic shock is not an independent disease, but a complication of the underlying pathology. Therefore, doctors need to do everything to prevent its development.
Cardiogenic shock: classification of the disease
Depending on the cause and pathogenesis, several forms of cardiogenic shock are distinguished. Each of them has its own development mechanism. However, all options lead to the same symptoms. Regardless of the cause of its occurrence, emergency care for cardiogenic shock is necessary in any case. Since this condition is always equally dangerous. The following types of this complication are distinguished:
- True cardiogenic shock. It develops with damage to heart tissue. In most cases, this form is due to transmural myocardial necrosis.
- Arrhythmic shock. Its causes include flickering and flutter of the ventricles, extrasystole, severe bradycardia. In addition to arrhythmias, a violation of the conduction of the heart can lead to shock.
- Reflex cardiogenic shock. With this option, a dysfunction of the heart does not precede a complication. Usually it develops with massive blood loss, renal failure.
- Areas shock. It is the most dangerous option. It is allocated in a separate group, since it almost always leads to death and is not amenable to treatment.
True Cardiogenic Shock: A Development Mechanism
True heart shock is most common. It occurs if most of the myocardium is affected (from 50% or more). In this case, necrosis spreads not only throughout the thickness of the muscle, but also occupies a large area. In addition to a heart attack, other diseases can lead to true shock. Among them: septic endocarditis, severe heart defects, decompensated myodystrophy, etc. Acute hyperthyroidism, some genetic pathologies also lead to severe cardiological disorders.
As a result of cardiac necrosis, contractility is significantly reduced. Therefore, the body cannot work at full strength and provide blood vessels. Minute volume is also reduced. In this case, an increase in vascular resistance occurs. Despite this, the heart still does not cope with its work. The result is a disturbed blood supply to all organs and tissues.
The pathogenesis of arrhythmic cardiogenic shock
At the heart of this form of the disease are violations of conduction and heart rhythm. They can occur both spontaneously (as a result of myocardial infarction), and develop gradually. Most often, arrhythmias bother the patient for many years. The same applies to conduction disturbances. Nonetheless, life-threatening conditions develop over a short period. It is about hours and even minutes. Most often, cardiogenic shock is caused by ventricular rhythm disturbances. Among them: tachycardia, which passes into fibrillation, and flutter. In addition, frequent group extrasystoles can lead to these processes.
Another condition that can lead to shock is sinus bradycardia. A decrease in heart rate is usually characterized by conduction disturbances. Atrial fibrillation and flutter less commonly leads to cardiogenic shock. As a result of pathological contractions and ectopic foci in the myocardium (extrasystoles), the heart cannot fulfill its function. Therefore, there is a decrease in stroke and minute volume, a drop in pulse pressure, and blood pressure. With this option, the ambulance doctor must first stop arrhythmia by defibrillation or artificial heart massage.
What is a reflex shock?
This form of shock develops due to causes that were not initially associated with damage to the heart muscle. The triggering mechanism of such a complication may be severe pain or bleeding. However, these symptoms are rarely associated with the heart. Usually, such a shock is diagnosed after an accident, acute renal failure.
This option has the most favorable prognosis. Emergency care for cardiogenic shock of a reflex nature should be aimed at eliminating its cause - pain, as well as stopping bleeding. Due to these factors, the regulation of vascular tone is disturbed. Because of this, blood stagnates in the veins and arteries, and fluid flows into the interstitial space, forming an edema. All this leads to a decrease in venous flow to the heart. Further, the mechanism is the same as with other forms.
Causes and pathogenesis of reactive shock
Areactive cardiogenic shock occurs if the entire myocardium is affected. This occurs with repeated heart attacks. Also, cardiac tamponade may be the cause. In this case, a fluid appears in the pericardium, which compresses the organ, preventing it from contracting. In some cases, tamponade can lead to rupture of the heart. This condition leads to death. Unfortunately, helping the patient in this case fails. The mechanism of development of shock is associated with a complete cessation of the heart, in contrast to other forms in which the minute volume decreases. Mortality from this complication is close to 100%.
Symptoms of Cardiogenic Shock
The clinical picture is the same, regardless of what reason caused the cardiogenic shock. Symptoms of complications are as follows: a drop in arterial and pulse pressure, tachycardia, oliguria (decreased diuresis). Depending on the size of blood pressure and clinical data, 3 degrees of severity are distinguished. Upon examination of the patient, other signs of cardiogenic shock can be detected. These include:
- Cold and clammy sweat.
- Fear of death or lack of consciousness.
- Cyanosis - cyanosis of the skin.
- The facial features of the patient may be pointed, facial expressions - suffering.
- Skin color in a severe degree acquires a gray tint.
How to diagnose shock?
Diagnosis of cardiogenic shock is usually based on clinical data and the questioning of the patient's relatives. Since it is necessary to act immediately, doctors evaluate blood pressure, the condition of the skin, the reaction of the pupils, heart rate and respiratory rate. If the patient has signs of shock, emergency care is immediately provided.
In the presence of free medical personnel, a medical history is revealed. The doctor asks: did the patient suffer from arrhythmia, angina pectoris, possibly suffered myocardial infarction earlier? If the complication developed at home or on the street, then the diagnosis of shock by emergency doctors ends there. When keeping the patient in the intensive care unit, in addition, they measure pulse pressure, vascular resistance, and urine output. The gas composition of the blood is also examined.
Cardiogenic shock: emergency care, action algorithm
It is worth remembering that the life of the patient depends on how quickly and efficiently the help is rendered. With signs of such a complication, doctors begin to take action immediately. If you do everything you need in time, you can defeat cardiogenic shock. Emergency care - the algorithm of actions is as follows:
- Lay the patient in a horizontal position with a raised leg end. In addition, it is necessary to provide air access (unfasten clothing, open a window).
- Oxygen supply. It can be carried out through a special mask or nasal catheter.
- Anesthesia. With myocardial infarction and reflex shock, drugs are used for this. Most often used medication "Morphine". It is diluted in physiological saline and injected iv slowly.
- Recovery of bcc and blood flow. For this, the introduction of a solution of "Reopoliglyukin."
- In the absence of effect, it is necessary to increase blood pressure with the help of Atropin 0.1%. Enter in an amount of 0.5-1 ml.
In addition, it is necessary to eliminate the cause of the shock. In case of myocardial infarction, thrombolytic and antiplatelet therapy is carried out (Alteplaza, Clopidogrel, Aspirin preparations). Also, to dilute the blood using a solution of "Heparin." In case of ventricular arrhythmias, the medication “Lidocaine” is administered. In some cases, defibrillation is necessary.
Inpatient emergency care
Emergency care for cardiogenic shock continues in the intensive care unit. Intensive therapy is carried out there , constant monitoring of indicators, the causes of the complication are clarified. With myocardial infarction, surgical treatment is performed - artery bypass surgery, stent placement. Surgical care is also necessary for some variants of arrhythmia and conduction disorders. At the same time, an artificial pacemaker is established that performs contractile function of the heart.