Cardiogenic Shock

WHAT YOU SHOULD KNOW

In the condition known as shock, the circulation of blood to the body's tissues drops below the point needed to maintain life. Shock is labeled cardiogenic when it's caused by the heart's inability to pump enough blood. Cardiogenic shock typically is triggered by a heart attack, and is definitely life-threatening. Even with treatment, it ends in death 65 to 80 percent of the time.

Causes

Cardiogenic shock can spring from disorders of the heart muscle, the heart valves, or the heart's electrical conduction system. Some 5 to 15 percent of patients hospitalized for heart attacks develop the condition. It may also stem from other cardiac problems, such as heart failure, cardiomyopathy (an inflammation of the heart muscle), rupture of the heart, irregular heartbeats (arrhythmias), and valve disorders.

Signs/Symptoms

The symptoms of cardiogenic shock include a weak and rapid pulse, rapid breathing, anxiety, cold hands and feet, fatigue, weakness, loss of ability to concentrate, confusion, agitation, profuse sweating, and decreased urine output. The skin is pale or moist, and cool to the touch.

Care

To correct this condition, the doctor will order medications to boost blood pressure and heart function.

Risks

If not treated promptly, cardiogenic shock can lead to damage of the kidneys, liver, brain, and other tissues, and may end in death.

WHAT YOU SHOULD KNOW

Cardiogenic shock is A MEDICAL EMERGENCY. Call 911 or 0 (operator) to get to the nearest hospital or clinic. Do not drive yourself!

While waiting for help to arrive:

• Lie down, face upward, with the feet elevated.
• Loosen tight collars, belts, and other restrictive clothing. Cover up with a blanket.
• If you're outside and it's a warm day, get in the shade.
• Stay as still as possible until help arrives.

IF YOU'RE HEADING FOR THE HOSPITAL...

What to Expect While You're There

You may experience the following procedures and equipment during your stay.

• Chest X-ray: This picture of the lungs and heart will help the doctor determine the cause of the problem.
• Taking Vital Signs: These include your temperature, pulse, blood pressure and respiration. A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm. These tests may be performed hourly.
• IV: This is a tube placed in your vein for giving medications, liquids, and blood products. It will either be capped or have tubing connected to it.
• Electrocardiogram: For this test, also known as an ECG, EKG, or heart monitor, several small patches (electrodes) will be applied to your chest. The patches are hooked up to a TV-type screen or small portable box that shows a tracing of each heartbeat.
• Echocardiogram: Also called an ECHO, this equipment uses sound waves to build a picture of your heart. Conductive jelly is applied to your chest and the device is placed on top of it.
• MRI: This is another imaging technique that helps the doctors assess the extent of the damage to your heart. To take this picture, you'll need to lie on a narrow bed that slides into a scanner.
• Cardiac Catheterization: This procedure provides movie-type x-rays of the arteries that send blood to your heart. It also measures blood pressure within the heart. A slender tube called a catheter is threaded through an artery in the arm or groin and up into the coronary arteries. The procedure is also referred to as coronary angiography.
• Blood Gases: Blood taken from an artery in your wrist, elbow, or groin will be tested for its oxygen content.
• Defibrillator: This is an electrical device that shocks the heart to reestablish normal rhythms.
• Oxygen: Because of the heart's inability to deliver sufficient oxygen-rich blood to the tissues, the doctor will boost your oxygen supply. It is given either through a mask or nasal prongs.
• Medicine:
  • Heart Medication: Given to improve heart performance and function.
  • Clot Busters: If the problem is the result of a heart attack, you may be given drugs to break up the clots obstructing the flow of blood to the heart muscle. They are given in your IV, and may be followed by other blood thinners. These medicines can make you bleed or bruise easily.
  • Analgesics: To relieve pain. These medications may be given in your IV, as a shot, or by mouth. If the pain does not go away or comes back, tell your doctor immediately.
  • Blood Pressure Medicine: The circulatory system needs enough pressure to push blood into the tissues, so you may be given drugs to increase blood pressure.
• Balloon Angioplasty: During this procedure, a balloon-tipped catheter is snaked into an obstructed coronary artery. The balloon is then inflated to squeeze back the blockage and restore a better flow of blood to the heart muscle. The technique can sometimes replace surgery.
• Surgery: In many cases, surgery may be needed to repair the cause of the damage.

After You Leave

• Once you've recovered, exercise daily. Regular exercise strengthens the heart.
• Eat a well-balanced diet low in fat, salt, and cholesterol.
• Maintain a healthy weight. Too much weight can put added stress on your heart.
• Learn to control stress by adopting new ways to relax such as deep breathing exercises, muscle relaxing techniques, meditation, or yoga.
• Get at least seven hours of sleep each night and nap during the day if you feel tired.
• Take an aspirin daily. It helps thin the blood. (For this purpose, ibuprofen and acetaminophen cannot be substituted for aspirin. They do not thin the blood.)
• If you smoke, quit. If you have trouble quitting, ask your doctor for help.

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