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Cardiogenic Shock

Cardiogenic Shock Treatment in Delhi, India

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Overview

Cardiogenic shock is a serious condition in which the heart is unable to pump enough blood to meet the requirement of the body. As a result, the heart is unable to provide sufficient blood to various vital organs of the body. It is because of the inability of the heart to supply adequate nutrients to the body the blood pressure level falls, and organs may begin to fail. This condition is most often caused post a severe heart attack. It's not necessary that everyone who gets a heart attack has a cardiogenic shock.

Cardiogenic shock is rare. It is often deadly if not treated immediately.

Cardiogenic Shock Symptoms

Signs and symptoms comprise of

  • Increased breathing rate
  • Severe Dyspnoea
  • Tachycardia
  • Loss of consciousness
  • Feeble pulse
  • Low blood pressure levels 
  • Sweating
  • Dull skin
  • Cold extremities
  • Inadequate episodes of Urination 
  • Anxiety
  • Fatigue

Cardiogenic Shock Causes

In the majority of cases, a lack of oxygen to the heart resulting from an episode of heart attack damages the left ventricle, which is the chief pumping chamber. Due to inadequate blood flow, the heart muscle can weaken and go into cardiogenic shock.

In rare cases of cardiogenic shock, the right ventricle, which is the bottom right chamber of the heart, is damaged. It is accountable for pumping blood to the lungs, where it gets oxygen and then is supplied to other parts of the body.

Other conditions that can result in cardiogenic shock are as follows:

  • Myocarditis: Inflammation of the heart muscle
  • Endocarditis: An inflammation around the inner lining of the heart and adjacent valves
  • Arrhythmias: Irregular heartbeat
  • Pericardial tamponade: Excessive fluid or, at times, blood around the heart
  • Pulmonary embolism: Blockage of an artery, mainly in the lung, by a blood clot

Diagnosis of Cardiogenic Shock

Cardiogenic shock is ideally diagnosed in an emergency setup. Doctors will look for various signs and symptoms of shock and accordingly perform certain tests to ascertain the cause involved. These tests include

  • Blood pressure measurement: People in shock do have very low blood pressure levels.
  • Electrocardiogram (ECG or EKG): This is a rapid and non-invasive test that records the electrical activity of the heart through electrodes placed on the skin. If there is the presence of damaged heart muscle or fluid accumulation around the heart, then it won't transmit electrical signals normally.
  • Chest X-ray: A chest X-ray depicts the size and shape of the heart and whether there is any presence of fluids near the lungs.
  • Blood tests: These are done to check for organ damage and infection levels in the body. An arterial blood gas test might be performed to measure the amount of oxygen in the blood.
  • Echocardiogram: This test can help to identify the damage resulting from an episode of a heart attack.
  • Cardiac catheterization (angiogram): This test can reveal the location of blocked or narrowed arteries. A doctor performs this test by inserting a catheter through an artery either in the leg or wrist region and guiding it to the heart. The dye passes through the catheter, making the arteries more easily seen on X-ray.

Cardiogenic Shock Treatment

Cardiogenic shock is a grave condition where patients require emergency treatment and care. The vital part of treatment is improving the flow of blood and oxygen to major organs to avoid damage.

Emergency Life Support

  • Most people who suffer from cardiogenic shock require extra oxygen. The patient is immediately put on a ventilator, and medications and fluid are administered through an IV line in the arm.

Medications

  • Fluids and plasma are administered through an IV line: Various medications to treat cardiogenic shock are given to increase the heart's overall pumping ability and also reduce the risk of blood clot formation.
  • Vasopressors: These are used to treat low blood pressure levels and include dopamine, epinephrine (Adrenaline, Auvi-Q), and norepinephrine (Levophed), among others.
  • Inotropic agents: This help to improve the pumping function of the heart and is given until other treatments begin to act. These include dobutamine, dopamine, and milrinone.
  • Aspirin: Aspirin is usually given in order to reduce blood from clotting and maintain blood flow through a narrowed artery. It is advised to take aspirin while waiting for help to arrive if the doctor has previously advised doing so for symptoms of a heart attack.
  • Antiplatelet medication: Emergency room doctors might give drugs similar to aspirin to prevent new clots from forming. 
  • Other blood-thinning medications: Other medications, such as heparin, are prescribed to make blood less likely to form clots. IV or injectable heparin usually is given during the first few days after a heart attack.

Surgical Procedures

Surgical procedures to treat cardiogenic shock focus on restoring blood flow through the heart. They include

Cardiogenic Shock Risk Factors

If the patient has an episode of heart attack previously, then the risk of developing cardiogenic shock increases by many folds if patients:

Complications of Cardiogenic Shock

If cardiogenic shock is severe and left untreated for too long, the organs won't receive a sufficient oxygen supply via the blood, which can lead to temporary or permanent organ damage.

For example, cardiogenic shock can lead to

  • Brain damage
  • Liver or kidney failure
  • Stroke
  • Heart attack
  • Permanent organ damage can lead to death.

Preventions of Cardiogenic Shock

Preventing repeated episodes of its root causes is key to preventing cardiogenic shock. This can be achieved by the prevention and treatment of the following:

Here are some tips to follow:

  • Seek immediate medical attention if patients are experiencing any symptoms that depict a heart attack.
  • If patients have a previous history of heart attacks, the doctor may prescribe various medications in order to keep the heart strong or help it recover after the episode of a heart attack.
  • If patients have high blood pressure levels or a history of heart attack, frequent doctor consultation is recommended to maintain and stabilize the blood pressure levels.
  • Exercise regularly to manage weight.
  • Consumption of a healthy diet to help manage cholesterol levels.
  • Reduce sugar intake. This will help to avoid nutrient-poor calories and help maintain a healthy weight.
  • Limit alcohol. If patients consume alcohol, it is advised to have moderate limits.

When to See a Doctor?

Immediate management of heart attack treatment drastically improves the chances of survival and reduces the damage to the heart. If patients experience the symptoms of a heart attack, they should call emergency medical services for help. It is to be noted that while on the way to emergency medical services, make someone drive to the nearest hospital. The patient shouldn't drive themselves.

Outlook/Prognosis

The impact cardiogenic shock has on the life of a patient depends on how quickly the treatment is received by the patient. The lesser time patients are in shock, the better it is for them because there is comparatively less damage to vital organs. Without treatment, this condition can lead to death.

Reviewed & Updated On

Reviewed by Dr. Viveka Kumar, Principal Director & Chief of Cath Labs (Pan Max) - Cardiac Sciences on 16-Jan-2023.


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