Cardiogenic shock

Cardiology (12%) Core Clinical Conditions

1B: Able to identify the condition as a possible diagnosis: may not have the knowledge or resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Definition

Cardiogenic shock is a potentially fatal condition that occurs when the heart is unable to pump sufficient blood to meet the needs of the body. There is a decreased blood flow to organs and tissues, despite the fact that there is sufficient blood in the body. It is generally caused by a severe myocardial infarction (MI), heart failure (HF), or other conditions that cause heart muscle damage. Common findings: sustained hypotension (systolic blood pressure below 90mmHg) and cold limbs and reduced urinary output (oliguria).

Aetiology

  • Severe MI which causes damage to the heart muscle and it is unable to pump blood effectively 

  • HF

  • Arrhythmias 

  • Complications following heart surgery 

  • Myocarditis 

  • Toxins or drugs

Pathophysiology

  1. Heart is unable to pump blood effectively to meet the body’s demands 

  2. Decreased organ and tissue perfusion 

  3. Reduced cardiac output which triggers the body's compensatory mechanism to keep the organs perfused

  4. activation of the sympathetic nervous system, renin-angiotensin-aldosterone system, and release of vasopressin and other vasoconstrictive substances.

  5. Despite compensatory mechanism the heart is still unable to perfused organs and tissues

Risk factors

  • Severe MI

  • Pre-existing heart disease 

  • Diabetes 

  • Hypertension

  • Age (older age)

  • Lifestyle: smoking, sedentary lifestyle, poor diet

Sign and symptoms

  • Tachycardia 

  • Irregular pulse 

  • Shortness of breath 

  • Tachypnoea 

  • Fatigue 

  • Altered mental status 

  • Chest pain 

  • Nausea / vomiting 

  • Dizziness 

  • Loss of consciousness / syncope

Investigations

  • Electrocardiogram (ECG) 

  • Bloods especially troponin 

  • CXR 

  • Echo

Management

  • Medications: vasopressors, inotropes or diuretics. These medications help improve blood pressure and improve blood flow. 

  • Oxygen therapy 

  • Heart surgery: percutaneous coronary intervention (PCI) or coronary artery bypass

 
 
 
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