Emergency care for cardiogenic shock, what you need, what you can’t do

Cardiogenic shock is a dangerous condition that is difficult to treat with medication, often leading to the death of the patient. Knowing the emergency care algorithm for cardiogenic shock, you can save the patient’s life by supporting the vital functions of the body before the ambulance arrives. How to recognize the first signs of a serious condition and what to do in an emergency, we will consider in the article.

What is cardiogenic shock, emergency care (the algorithm of which is presented below), how can one save a person’s life with this phenomenon? What are the causes and symptoms of this pathology?

This is a severe form of human condition, as a result of which there is a sharp change in blood pressure. It decreases, minute and shock volumes of blood are observed. Shock occurs mainly in people who have had myocardial infarction. As a result of this disease, you can lose consciousness, and almost 90% of cases are fatal.

The first signs of cardiogenic shock are:

  1. 1. Pale face and lips, blue fingertips.
  2. 2. Increased fatigue and weakness of the body.
  3. 3. Inhibited reaction and unreasonable anxiety.
  4. 4. Fear of death.
  5. 5. Swollen veins on the neck.

As a result of the above symptoms, respiratory arrest and loss of consciousness occur, and if first aid is not provided in time, then a person may die.

According to some criteria, it is possible to assess the severity of this disease, for example, by indicators of blood pressure and the expression of oliguria.

The first degree – the duration of the shock state is from 1 to 3 hours, Blood pressure drops to about 90/50 mm, a person responds quickly enough to drug therapy, heart failure is weak or absent;

During the second degree, the duration of the state of shock is from 5 to 10 hours, and blood pressure decreases to 80/50 mm Hg. At this stage, the patient responds more slowly to therapy, the primary signs of heart failure appear;

The third phase of severity is expressed in the most acute form. The time of the shock state is the longest, the symptoms of heart failure are acute, the pressure drops to 20 mm, pulmonary edema is possible, as a result of which the person is practically unable to breathe.

When diagnosing a patient, the following symptoms are revealed:

  • dryness and pallor of the skin of the body and face;
  • low body temperature;
  • increased sweating;
  • rapid pulse;
  • labored breathing;

Diagnostic procedures include ECG to accurately determine the diagnosis and assist. Diagnostic steps:

  • Initially, a survey of the patient and his close relatives is carried out;
  • then a general examination of the patient is carried out;
  • measure blood pressure, body temperature and pulse of a person;
  • listen to the heartbeat;
  • urine tests are performed and kidney function is assessed.

It is necessary to accurately and quickly determine the diagnosis and the degree of development of the disease. In this case, not a minute should be missed, because a person’s life depends on it. Be sure to pay attention to external symptoms and signs, to make sure the patient had myocardial infarction, to examine the blood.

What forms of cardiogenic shock exist? It is of three types: arrhythmic, true and reflex. So, with arrhythmic disturbed functions that regulate the frequency of the heart. If his rhythm is restored, the shock state will disappear.

Reflex is a weaker form, caused by a decrease in blood pressure as a result of a heart attack. If you take the necessary actions on time, then the pressure normalizes, and if you “close your eyes to it”, then the transition to true shock is inevitable.

Such a shock can develop after a myocardial infarction, due to a weakening of the functions of the left stomach. In this case, death is 100%.

Why cardiogenic shock can occur, what are the causes of its manifestation and what affects this?

This problem can develop in both children and adults. The most basic reason is myocardial infarction, which gives a severe complication. Not so often, the disease can occur with poisoning with a cardiotoxic substance. And also shock occurs due to:

  • severe arrhythmias;
  • pulmonary embolism;
  • disorders of the heart – the “pump” in the human body;
  • intracardiac bleeding.

So, due to the last two reasons, the heart is not able to supply blood to the brain and the human body in full. Therefore, ischemia or acidosis may develop, which complicate the process in the myocardium, which entails a fatal outcome of the patient.

Cardiogenic shock emergency algorithm:

  1. 1. First of all, it is necessary to lay the patient on a horizontal surface and raise his legs a little in order to increase the flow of blood to the brain.
  2. 2. Then you need to provide the affected person with the maximum amount of fresh air. For example, if you are indoors, you need to open a window.
  3. 3. The victim must unbutton his shirt or take off his tie (if any.)
  4. 4. If there is a lack of air, make artificial respiration.
  5. 5. Give an analgesic.
  6. 6. Next, do not forget about blood pressure. At low – apply drugs that include: hydrocortisone, metazone or dopamine.
  7. 7. The last point is indirect cardiac massage.

Emergency care for cardiogenic shock is necessary for the patient. If you perform this simple algorithm of actions, you can slightly alleviate the pain to a person.

The purpose of this treatment is to eliminate pain, increase blood pressure, and normalize heart rate.

In cases such as cardiogenic shock, doctors use drugs with a mild narcotic effect. Intravenously drip the patient with a glucose solution to increase blood sugar. Vasopressor drugs are used to increase blood pressure. Doctors can also use hormonal drugs.

When the pressure stabilizes, the patient is given sodium nitrosorbide, which dilates blood vessels and improves microcirculation. If, nevertheless, a cardiac arrest occurs, then an indirect massage is performed, if necessary – defibrillation.

Be sure to try to take the victim to the hospital, because this can save his life. In modern hospitals there are new technologies, for example, counterpulsation. This method allows you to fill blood vessels.

Sometimes you have to take extreme measures. Surgery is percutaneous angioplasty. This operation helps to restore the patency of the arteries, but it must be carried out no later than 7 hours after the onset of the attack.

In order to completely avoid such attacks, some kind of prevention should be followed. It includes:

  • regular physical activity in at least a small amount;
  • proper nutrition, the adoption of organically healthy foods;
  • complete cessation of smoking;
  • calm, which is expressed in not exposing the nervous system to stressful conditions.

The last and most important and significant point of prevention is the use of medications prescribed by a doctor to eliminate pain and impaired heart function.

With cardiogenic shock, as with any other diseases, complications can occur. For example, the initial signs of kidney or liver failure, ulcer, cerebral thrombosis. Pulmonary blood flow may decrease, and this in turn will increase blood acidity.

Unfortunately, cardiogenic shock often causes death. Despite the fact that the patient spent very little time in this condition, there are many complications (pulmonary infarction, spleen, necrosis, hemorrhage, cardiac arrhythmias), which doctors are trying to actively fight, but even they do not always succeed. According to statistics, only 10% of cases cope with cardiogenic shock.

Given the fact that half of them die in connection with heart failure, the statistics are disappointing. The remaining 90% are also fatal. But it is worth remembering that timely prevention, diagnosis and examination will help prevent the development of the disease or stop its growth at an early stage.

Cardiogenic shock is a serious complication of myocardial infarction and other heart pathologies. At the same time, first aid for cardiogenic shock is very important – the patient’s prognosis will depend on this. Therefore, it is very important for each person to know how to recognize such an emergency condition and how to help the patient in such a situation.

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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.

This condition is characterized by a sharp drop in blood pressure and a deterioration in the supply of blood to all human tissues and organs.

This is due to a sharp dysfunction of the heart muscle and a decrease in cardiac output. Alas, but due to too rapid irreversible consequences, only 10% of patients manage to be saved in a similar situation.

For reasons of occurrence, cardiogenic shock is usually divided into 2 main types. Not only further treatment will depend on this, but also first aid:

  1. Reflex. In this case, a sharp drop in blood pressure is caused by sharp pain, which usually accompany an extensive heart attack. If the patient is immediately given an anesthetic, the condition should gradually normalize. That is why when helping a patient with a heart attack, it is necessary to enter analgesics immediately to initially prevent the development of a shock condition.
  2. True. It develops due to prolonged failure to provide assistance to the patient, when necrotic changes affect already significant areas of the heart muscle. It manifests itself in the form of a weakening of the pumping function of the left ventricle.

This condition usually develops quickly and can occur due to the following reasons:

  • extensive myocardial infarction;
  • pathology of the valves (narrowing or insufficiency);
  • blockage of a thrombus of a pulmonary artery;
  • congenital heart defects (most often provoke the development of shock in children).

According to statistics, myocardial infarction is the most common cause of this emergency.

Main symptoms

Symptoms of cardiogenic shock are almost the same, regardless of the type of shock and the reasons for its development.

They occur in almost every patient with this disease:

  • a sharp change in the color of the skin (a person becomes pale, fingers and lips turn blue);
  • the pulse becomes frequent, but it is very difficult to feel it;
  • confused consciousness manifests itself in a person, and sometimes even his loss;
  • clammy and cold sweat covers the whole body;
  • severe sharp chest pain;
  • rapid breathing.

The main difficulty in this situation is that such symptoms are also characteristic of many other diseases of the cardiovascular system, therefore it is strictly forbidden to give the patient any medications and make their own diagnoses. This can lead to an even greater aggravation of the situation, therefore only a doctor in a hospital can make a final diagnosis and take measures based on ECG readings and blood pressure measurements.

How to recognize a dangerous condition

The sooner help is provided with cardiogenic shock, the more chances there are to save the patient’s life. The clinic always depends on the condition that caused the shock. With myocardial infarction, a person experiences severe pain in the chest, there is a feeling of fear, panic. In case of heart rhythm failures, the patient notes pain behind the sternum, there is a sinking heart or, conversely, an increase in heart rate. If thromboembolism of the pulmonary artery becomes the cause of cardiogenic shock, a person suffocates, weakness appears, sometimes a cough with blood.

Cardiogenic shock causes acute chest pain and other symptoms

Further development of shock is accompanied by such signs:

  • the appearance of cold, sticky sweat;
  • blue lips, nose, fingertips;
  • pallor of the skin;
  • anxiety of the patient or his lethargy;
  • swelling of the cervical veins;
  • lower temperature of the limbs;
  • feeling of panic and fear.

With pulmonary thromboembolism, the skin on the head, in the chest and neck becomes an earthy or marbled hue.

Degrees of 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.

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.

First aid emergency

If signs of cardiogenic shock are detected, it is necessary to call an ambulance as soon as possible and provide emergency assistance to the person. To do this, follow these steps:

  • Lay the patient on any surface, the body should be in a horizontal position, the legs are slightly raised. This position provides the best blood flow to the brain.
  • During emergency care, it is important that fresh air is allowed into the room. To do this, open the window or front door. No crowds should be allowed near the victim.
  • The neck and chest of a person must be freed from clothing. If there is a tight collar, tie, scarf or other objects, they must be removed.
  • At the initial stage, you need to measure the patient’s blood pressure. With cardiogenic shock, it is always lowered. To normalize the indicators, you need to give the patient a drug that includes dopamine, metazone or hydrocartisone.
  • If the person is conscious, it is allowed to take analgesic drugs.

After this, you should wait for the ambulance, after the doctors arrive, tell them under what circumstances the shock developed.

First aid for the development of shock should be immediate

Cardiogenic Shock Emergency Algorithm

The most unpredictable period in relation to the development of this complication is the first hours after a heart attack. All this time, the patient should be in intensive care under the close supervision of doctors.

Among the risk factors that lead to the development of this condition, in cardiology there are:

  1. Poisoning with cardiotonic agents that stimulate contractile activity of the heart.
  2. Myocardial infarction, previous.
  3. Violations of the function of conduction of the heart.
  4. Diabetes.
  5. A large area of ​​damage affecting all the membranes of the myocardium (transmural infarction).
  6. Abnormal heart rhythm associated with premature ventricular contraction.

The etiology of cardiogenic shock in addition to acute myocardial infarction is associated with the following pathologies:

  • violation of the structure of the vascular wall between the ventricles (aneurysm of the interventricular septum or its rupture);
  • pathological thickening of the wall of the left ventricle (hypertrophic cardiomyopathy);
  • inflammation of the middle layer of the myocardium – myocarditis;
  • impaired functioning of the valvular apparatus and large vessels (valvular insufficiency, aortic stenosis);
  • valve pneumothorax (accumulation of air in the pleura);
  • ventricular tamponade with effusion;
  • bleeding inside the heart;
  • pericarditis (inflammation of the pericardial bag of infectious genesis);
  • clogging of the lumen of the trunk of the pulmonary artery with an embolus (clot).

Collapse, or reflex shock, is one of the varieties of a shock state different from a true cardiac shock. The reflex form is considered the most favorable for treatment, since with timely assistance, it is possible to restore the normal functioning of cardiac activity and hemodynamics.

In the case of cardiogenic shock, most resuscitation measures, according to statistics, are fatal. The shock state is characterized by a decrease in pumping function as a result of severe myocardial damage. With collapse, acute vascular insufficiency and a decrease in vascular tone are of primary importance.

Cardiogenic shock is also accompanied by a decrease in venous and arterial pressure (BP), a decrease in the volume of blood circulating in the body. The difference is that with a cardiocardium, these deviations are not directly related to pain shock, but to a drop in shock and minute release as a result of a decrease in contractile activity.

In differential diagnosis, cardiopulmonary traumatic shock should be distinguished from collapse. It has two phases – erectile (excitation) and torpid (inhibition). In this case, the shock condition does not develop from cardiological pathologies, but from severe injuries, accompanied by massive blood loss as a result of external mechanical damage.

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.

One of the most frequent and dangerous complications of myocardial infarction is cardiogenic shock. This is a difficult condition of the patient, which in 90% of cases ends in death. To avoid this, it is important to correctly diagnose the condition and provide emergency care.

The extreme phase of acute circulatory failure is called cardiogenic shock. In this state, the patient’s heart does not perform the main function – it does not provide all the organs and systems of the body with blood. As a rule, this is an extremely dangerous result of acute myocardial infarction. In this case, experts provide the following statistics:

  • in 50%, the shock condition develops in 1-2 days of myocardial infarction, in 10% – at the prehospital stage, and in 90% – in the hospital;
  • if myocardial infarction with a Q wave or ST segment elevation, a shock condition is observed in 7% of cases, moreover, after 5 hours from the onset of symptoms of the disease;
  • if myocardial infarction without Q wave, a shock condition develops up to 3% of cases, and after 75 hours.

To reduce the likelihood of developing a shock condition, thrombolytic therapy is performed, in which blood flow in the vessels is restored due to lysis of the thrombus inside the vascular bed. Despite this, unfortunately, the probability of a fatal outcome is high – in the hospital, mortality is observed in 58-73% of cases.

Causes

External causes can provoke cardiogenic shock:

  • acute form of myocardial infarction of the left stomach, which is characterized by a long-term non-arrested pain syndrome and an extensive site of necrosis, provoking the development of heart weakness;

If ischemia spreads to the right stomach, this leads to a significant aggravation of shock.

  • arrhythmia of paroxysmal species, which is characterized by a high pulse frequency during gastric myocardial fibrillation;
  • blocking the heart due to the impossibility of carrying out the pulses that the sinus node must supply to the stomachs.

A number of external causes leading to cardiogenic shock are as follows:

  • the pericardial sac (the cavity where the heart is located) is damaged or inflamed, which leads to compression of the heart muscle as a result of the accumulation of blood or inflammatory exudate;
  • lungs rupture, and air enters the pleural cavity, which is called pneumothorax and leads to compression of the pericardial sac, and the consequences are the same as in the previous case;
  • thromboembolism of the large trunk of the pulmonary artery develops, which leads to impaired blood circulation through the small circle, blocking the work of the right stomach and tissue oxygen deficiency.

Signs indicating cardiogenic shock indicate a violation of blood circulation and externally manifest in such ways:

  • the skin turns pale, and the face and lips become grayish or bluish in color;
  • cold, sticky sweat is released;
  • pathologically low temperature is observed – hypothermia;
  • hands and feet get colder;
  • consciousness is disturbed or inhibited, and short-term excitement is possible.

In addition to external manifestations, cardiogenic shock is characterized by such clinical signs:

  • blood pressure critically decreases: in patients with severe arterial hypotension, systolic blood pressure is below 80 mm Hg. Art., and with hypertension – below 30 mm RT. st .;
  • jamming pressure of pulmonary capillaries exceeds 20 mm Hg. st .;
  • the filling of the left ventricle increases – from 18 mm RT. Art. and more;
  • cardiac output is reduced – the cardiac index does not exceed 2-2,5 m / min / m2;
  • pulse pressure drops to 30 mm RT. Art. and below;
  • the shock index exceeds 0,8 (this is an indicator of the ratio of heart rate and systolic pressure, which is normally 0,6-0,7, and in shock it can even rise to 1,5);
  • a drop in pressure and vasospasm leads to a small excretion of urine (less than 20 ml / h) – oliguria, and complete anuria (cessation of urine into the bladder) is possible.
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The following phenomena occur:

  1. The physiological balance between the tone of the two parts of the autonomic nervous system – sympathetic and parasympathetic – is disturbed.
  2. The central nervous system receives nociceptive impulses.

As a result of such phenomena, a stressful situation arises, which leads to an insufficient compensatory increase in vascular resistance – reflex cardiogenic shock.

This form is characterized by the development of collapse or sharp arterial hypotension, if the patient suffered a myocardial infarction with an undecided pain syndrome. The collaptoid state is manifested by vivid symptoms:

  • pale skin;
  • increased sweating;
  • low blood pressure;
  • heart rate increase;
  • low filling of the pulse.

Reflex shock is of short duration and, thanks to adequate analgesia, is quickly relieved. To restore central hemodynamics, small vasopressor drugs are administered.

Arrhythmic

Paroxysmal tachyarrhythmia or bradycardia develops, which leads to hemodynamic disorders and cardiogenic shock. Heart rhythm disturbances or its conduction are noted, which becomes the cause of a pronounced disorder of central hemodynamics.

The symptoms of shock will disappear after the abnormalities are stopped, and the sinus rhythm is restored, as this will lead to a quick normalization of the superficial function of the heart.

An extensive myocardial damage occurs – necrosis affects 40% of the myocardial mass of the left stomach. This is the reason for a sharp decrease in the pumping function of the heart. Often, such patients suffer from the hypokinetic type of hemodynamics, in which symptoms of pulmonary edema are often manifested.

The exact signs depend on the jamming pressure of the pulmonary capillaries:

  • 18 mmHg Art. – congestive manifestations in the lungs;
  • from 18 to 25 mm RT. Art. – moderate manifestations of pulmonary edema;
  • from 25 to 30 mm RT. Art. – pronounced clinical manifestations;
  • from 30 mm RT. Art. – The whole complex of clinical manifestations of pulmonary edema.

As a rule, signs of true cardiogenic shock are detected 2-3 hours after myocardial infarction has occurred.

Areactive

This form of shock is similar to the true form, with the exception that it is accompanied by more pronounced pathogenetic factors that are continuous. With such a shock, any therapeutic measures do not affect the body, which is why it is called areactive.

Myocardial rupture

Myocardial infarction is accompanied by internal and external myocardial ruptures, which is accompanied by the following clinical picture:

  • pouring blood irritates the pericardial receptors, which leads to a sharp reflex drop in blood pressure (collapse);
  • if there is an external rupture, tamponades of the heart prevent heart contraction;
  • if an internal rupture occurs, certain parts of the heart receive a pronounced overload;
  • myocardial contractile function decreases.

Diagnostic measures

Medical events

In case of loss of consciousness and respiratory arrest, urgent resuscitation is necessary. Artificial respiration is performed mouth to mouth. To do this, the person’s head must be thrown back by placing a roller from a towel or any other fabric under the neck. The person performing resuscitation must inhale air, close the victim’s nose with his fingers, exhale air through the victim’s mouth. Up to 12 breaths must be completed in one minute.

During the provision of first aid, it is necessary to monitor the patient’s pulse. If a person loses consciousness and heart beats are not heard, you need to perform an indirect heart massage. For its implementation, the patient is placed on his back, the surface must be solid. The person performing the massage should be located on the side of the patient.

Important! While performing artificial respiration and indirect heart massage, 2 breaths with 30 tremors should be alternated.

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.

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 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.

The help to the patient in the conditions of a hospital

The algorithm of actions of doctors depends on the characteristics of the patient’s condition. The first medical events are still in the ambulance. The following methods are used here:

  • the use of oxygen therapy – the procedure helps to maintain the patient’s breathing, maintain vital functions before arriving at the hospital;
  • the use of narcotic analgesics. This exercise helps reduce severe pain. It uses drugs such as droperidol, promedol, fentanyl and others;
  • to eliminate the risk of blood clots in the arteries, heparin is administered to the person;
  • solutions of Dobutamine, Dopamine, Norepinephrine help normalize heart rate;
  • the introduction of glucose insulin helps improve heart muscle nutrition;
  • Panangin, Giluritmal, Lidocaine help eliminate tachyarrhythmia;
  • a solution of sodium bicarbonate is introduced to establish the metabolic processes of the body.

Further treatment of cardiogenic shock in a clinic involves the continuation of therapy, begun at home and in the ambulance. When a patient enters the hospital, an immediate comprehensive examination of the body is carried out. This helps to identify contraindications and the risk of side effects that can trigger a complication of the situation.

In a hospital, resuscitation measures are carried out aimed at restoring the patient’s vital functions

A further standard of care depends on the disease that caused the development of shock:

  • a condition in which pulmonary edema occurs, requires the appointment of Nitroglycerin, the use of alcohol solutions, diuretics;
  • severe pain is relieved with the help of strong narcotic analgesics, which include Morphine, Promedol, Fentanyl;
  • treatment of severely lowered blood pressure is carried out using a Dopamine solution;
  • to maintain breathing in the patient in an unconscious state, tracheal intubation is performed;
  • Oxygen therapy helps prevent oxygen deprivation of the brain and other organs.

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.

First aid and treatment

What is cardiogenic shock is approximately clear from the name of the pathology – the word “shock” itself speaks for itself and means an uncontrollable state in the extreme stage of complication.

Everywhere where the basis of the term “cardio” is present, we are talking about the heart. In this case, with cardiogenic shock, the causes of the occurrence provoke left ventricular heart failure.

Cardiogenic stroke is characterized by a sudden and rapid decline in the contractile function of the heart muscle (myocardium).

Cardiogenic shock is characterized by a limitation of shock release of blood, which entails an acute form of oxygen deficiency in tissues in vital organs.

Normally, blood circulation functions due to the contractile power of the heart muscle, resistance in the vessels and arterial tone.

The more often and the deeper the heart rate, the more blood is distributed throughout the body, supplying each organ with oxygen and nutrients.

Four main sources of cardiogenic stroke:

  1. Violation of the pumping activity of the myocardium or heart rhythm.
  2. Filling the ventricular cavities with effusion.
  3. Tamponade by the blood mass of the heart bag.
  4. Extensive pulmonary embolism.

In simple terms, the state of a cardiogenic shock state is explained by the inability of the heart to push blood substance into the vessels. The absence of vascular tone is expressed in their inability to hold and direct blood flow, because the vessels are relaxed and are in a constant expanded position.

As a result of such a cardiogenic stroke, blood pressure is greatly reduced.

The brain suffers first, since the blood simply does not reach it, and it undergoes oxygen starvation. After about 20 seconds, due to shock and loss of blood supply, the brain begins to lose many of its functions irrevocably. And after a few minutes, the death of the cerebral organ, and therefore the whole organism.

That is why during cardiogenic shock emergency care is needed in the first seconds of the development of pathology. If it is not possible to begin resuscitation within the first minute, the state of a cardiogenic stroke ends in death. Hence, such disappointing statistics – mortality in 90% of cases.

The source of cardiogenic stroke can be either internal (heart) or external (vessels surrounding the heart).

Internal causes of cardiogenic shock:

  • Sudden left ventricular myocardial infarction. It manifests itself as an acute pain syndrome and a sharp weakening of the heart muscle, due to large-scale necrosis of the heart tissues.
  • Violation of contraction of the heart muscle due to atrial paroxysmal arrhythmia.
  • Full-blown heart block associated with the impossibility of conducting impulses from the sinus node of the heart to the heart ventricles.

External factors provoking cardiogenic shock:

  • Traumatic or inflammatory processes that damage the integrity of the pericardial sac. In the cavity where the heart is located, blood fluid or inflammatory exudate begins to accumulate. Biological fluids exert pressure on the myocardium, which leads to cardiac arrest.
  • The pressure on the heart muscle can also be caused by the accumulation of air in the pleural cavity (pneumothorax). The cause of this pathological process is rupture of the lung.
  • The progression of thromboembolism of the large trunk of the artery of the lung leads to a violation of the pulmonary circulation. And thus it blocks the activity of the right ventricle and leads to massive oxygen deficiency.

Cardiogenic shock classification implies a grouping of clinical manifestations depending on the severity of the patient.

Clinical phase I (mild) grade II (moderate) grade III (severe) gradeDuration of cardiogenic stroke

hours before 4from 5 to 8 hourslonger than 8 hoursTachycardia (how many strokes per minute)

100-110about 120filamentous pulse, low tonesArterial pressure

systological in the range of 90-60, lower from 60 to 40systological in the range of 80–45, lower value from 50 to 25not detectedCharacteristic features

may not be traceablepancreatic insufficiency is observedpulmonary edemaResuscitation Response

normalslow and unstableshort-term or completely absent

    True cardiogenic shock is expressed in lesions of more than half of the muscle volume of the heart. With insufficient intake of blood flu >

Symptoms of cardiogenic shock are associated with a violation in various parts of the blood circulation.

When examining the patient, there is a sharp drop in pressure, lack of pulse when palpating the radial artery and a barely noticeable beating on the carotid artery.

The state of shock always develops at lightning speed, seconds are allocated for diagnosis. But experienced doctors of the ambulance team can always determine a cardiogenic stroke by the following characteristic symptoms.

The main signs of cardiogenic shock:

  • The fall of the minimum acceptable level of systolic pressure in the arteries below 80 millimeters of mercury.
  • Prolonged pain in the chest area that does not stop after the use of nitroglycerin and other nitrate-containing products.
  • Blanching or gray tint of the skin.
  • Heart palpitations and interruptions in heart rate.
  • Blue fingertips and nasolabial area.
  • The appearance of cold, sticky sweating, a decrease in overall body temperature.
  • Cold on tactile examination of the upper and lower limbs.
  • Oliguria – scanty urination, and subsequently the cessation of its allocation.
  • Inhibition or loss of consciousness right down to a coma.
  • Shortness of breath (with thromboembolism).
  • Pulmonary edema, accompanied by suffocation, severe shortness of breath, pain and heaviness in the chest.
  • Varicose veins in the neck.

Cardiogenic shock symptoms may occur partially. Only in the severe phase can most of the signs of cardiogenic shock pathology be observed.

The severity of cardiogenic stroke is evidenced by the duration of the condition and especially the reaction to the use of pressor amines.

With a shock duration of more than six hours, poor response to medications and an increase in arrhythmia in combination with pulmonary edema, one can judge about reactive shock.

Cardiogenic shock can overtake a person anywhere. It is important for others not to get confused, but to take the right actions regarding the victim. First of all, you need to call an ambulance, suffering from an attack of shock, to plant so that your legs are slightly raised and, if possible, surround with pillows.

Release from constricting elements of clothing, unfasten the collar.

If a person with a cardiogenic shock in consciousness, you need to try to help him calm down. In the absence of a pulse, you will need to carry out urgent pre-medical resuscitation, including cardiomassage with a frequency of pressing a hundred times in 60 seconds and artificial respiration two breaths every 14 pressures on the heart area.

Emergency care for cardiogenic shock includes the following sequence of actions:

  • Blood pressure rise in arteries.
  • Elimination of pain.
  • Elimination of tachycardia.
  • Heart rate increase to a normal level.
  • The use of cerebral neurotransmitters.
  • The introduction of an anti-shock drug (reopoliglyukin), which restores capillary blood flow and other measures.

After carrying out all the necessary emergency measures for cardiogenic shock, the patient is taken to a hospital for full therapy. Cardiogenic shock is treated by providing moistened oxygen to the lungs through inhalation. Action against shock depends on the severity and classification of the pathology.

And may include electropulse therapy, defibrillation, coronary angioplasty and other methods. In the case of the ineffectiveness of drugs and tools directed against shock, the patient is satisfied with the injection of arterial blood flow using a balloon device.

But, despite the great opportunities in the field of medicine, the survival rate with cardiogenic stroke is negligible, only about 10%.

If the patient’s condition with cardiogenic shock does not improve after the use of drug therapy and resuscitation measures, doctors use surgical intervention to help save a person’s life. The operation is carried out exclusively in a hospital using the necessary medical equipment.

Diagnostics

Diagnosis of cardiogenic shock is based on typical clinical signs. It is much more difficult to determine the true cause of the shock. This must be done to clarify the scheme of forthcoming therapy.

At home, the cardiological team does an ECG examination, signs of acute heart attack, type of arrhythmia or blockade are determined.

In a hospital, an ultrasound of the heart is performed according to emergency indications. The method allows to detect a decrease in contractile function of the ventricles.

According to the chest radiograph, thromboembolism of the pulmonary artery, altered contours of the heart with defects, pulmonary edema can be established.

As treatment progresses, the doctors of the intensive care unit or intensive care unit check the degree of oxygen saturation of the blood, the work of internal organs according to general and biochemical analyzes, and the amount of urine taken into account.

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.

The diagnosis is made during the physical examination of the patient at the time of the initial examination based on the following diagnostic criteria: blood pressure level, analysis of respiratory activity, listening to heart sounds, determining the nature of the pulse, the color of the skin and the characteristics of the pain syndrome.

Only after providing emergency care and stabilizing the blood circulation process, a comprehensive diagnosis is carried out in a hospital hospital.

To do this, use the following methods:

  • hemostasiogram – a study of the functioning of the blood coagulation system;
  • pulse oximetry – determination of the degree of saturation of blood with oxygen;
  • biochemical analysis of blood for electrolytes – assessment of electrical conductivity and chemical composition;
  • a blood test for cardiac enzymes, since when the heart muscle is damaged, their content in the blood serum increases significantly;
  • determination of the gas composition of the blood is necessary to make a decision on the procedure for ventilation;
  • X-ray of the chest is performed in order to assess congestive processes in the pulmonary circulation, to identify signs of pulmonary edema;
  • coronary angiography – a method for the study of blood vessels, in which a radiopaque substance is injected into the artery cavity to identify areas of damage;
  • electrocardiography (ECG) diagnoses the stage of a heart attack, the nature of focal lesions, their location, the depth of necrosis, its scale;
  • echocardiography (ultrasound of the heart) and computed tomography are performed to assess the volume of cardiac output, contractile function, examination of tissues and cardiac structures.

First aid for cardiogenic shock

Properly taken measures in the provision of first aid can prolong the life of a person by an order of magnitude. Therefore, it would not hurt every citizen to have a good understanding of general medical concepts in this area.

In addition, there are no complex terms and actions here and cannot be, they must be left to qualified specialists, and an ordinary person needs to know the following algorithm :.

  • complete peace is what is needed first. To do this, lay an unhealthy person on his back and provide him with this condition;
  • call an ambulance at a fast pace. To achieve a quick doctor’s arrival, the symptoms should be described as clearly and clearly as possible;
  • before the team of doctors arrives, you need to help a person raise his legs, and let the blood flow better to the heart organ;
  • unhindered air flow is what the patient needs during this period. To do this, you can open windows and doors, unfasten tight clothes, etc .;
  • to alleviate pain, you can introduce special narcotic substances to the patient (analgesics);
  • in this state, it is necessary to control every change in blood pressure;
  • if a person’s condition has deteriorated by an order of magnitude and led to clinical death, then rehabilitation measures should be taken, such as indirect heart massage and artificial respiration;
  • at the moment when a team of doctors arrived at the place, it is necessary to give them all the information about the events.

These simple actions are the first aid for cardiogenic shock, which can not only help the patient, but possibly save his life.

It is worth saying that in the presence of this syndrome, transportation of a person is prohibited, which is why all doctors give all their strength to get him out of this condition, and only then they are taken to a medical institution using a special resuscitation car.

The algorithm of action depends on the form and symptoms of cardiogenic shock

Important! It is necessary to clarify that all these stages of emergency care are aimed at stopping the pain syndrome, which in this case has a pronounced character.

Cardiogenic shock refers to serious and serious conditions, and therefore, first of all, it is necessary to issue an emergency call to the ambulance team if someone has symptoms characteristic of this condition.

In this case, it is very important to explain in detail the manifestations and previous events, so that the dispatcher could send an appropriate team that has the necessary equipment and medications to help just such patients. After this, it is necessary to proceed directly to providing first aid to the patient. If cardiogenic shock develops, an emergency care algorithm should be as follows:

  • lay the person in a horizontal position, try to calm him down as much as possible;
  • open the window, untie the tie, unfasten the buttons of the shirt – do everything necessary to ensure maximum air access to the patient;
  • Raise your legs slightly – this will provide a greater flow of blood to the heart. It is also recommended that the patient’s head be slightly raised to avoid tongue sticking;
  • monitor breathing and heartbeat. This is very important, since in case of their absence, it is necessary to immediately proceed to resuscitation (heart massage and artificial respiration).

The only thing that can be given from a medication to a patient is pain medication (Baralgin). This will help to suspend even greater deterioration of the patient due to reflex hypotension.

If it is possible to find out that the patient himself had taken any medications before, then emergency doctors need to tell in detail about what kind of drugs they were, when and in what doses they were used. In addition, it is also advisable to periodically measure the blood pressure and pulse of the patient, record these data, so that later they can show the dynamics of the condition to the doctors.

Treatment method

Before delivering a patient to a hospital, it is necessary to stabilize his condition at least a little. To do this, doctors begin to provide assistance on the spot as soon as they come to the call. To do this, they primarily use the following methods:

  • the introduction of painkillers. It is these drugs that will help to stop a further drop in blood pressure. In this case, non-narcotic painkillers are used;
  • improved myocardial function to increase the frequency of contractions. This is the most necessary measure, which helps not only increase blood pressure, but also improve blood supply to organs and tissues of the body;
  • heart rate improvement, namely, normalization of the rhythm.

All other actions will be carried out directly in the hospital. There the patient will be given the appropriate drugs, constant monitoring of his vital indicators will be carried out (if necessary, the patient is connected to an artificial life support device). Also there, the patient must conduct regular examinations.

In addition, efforts must be made to eliminate the dangerous consequences of cardiogenic shock (pulmonary edema, damage to the liver, kidneys, brain), as well as directly to combat the root cause of the development of the disease. For this, therapy is prescribed to treat myocardial infarction, if necessary, in some cases a surgical operation is performed.

In any case, this will be determined solely on the basis of a detailed detailed examination of the patient’s condition. But first of all, all actions must be directed at stopping the main symptoms of shock and stabilizing the patient’s condition. Further, it is already necessary to conduct complex therapy aimed at treating the root cause of shock. Otherwise, the situation may repeat with continued exposure to the body of provoking factors.

So, taking into account a very unfavorable prognosis in the event of a similar emergency, it is recommended first of all to pay attention to preventive measures.

At the first manifestations of symptoms, which may indicate heart problems, it is necessary to call an ambulance as soon as possible, as well as take pain medications.

You can’t endure heartache! Indeed, this is precisely the main reason for the development of reflex cardiogenic shock. That is why it is so important to carefully monitor your health, especially if you have a predisposition to heart disease, so that you can immediately take measures at the first alarming symptoms.

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 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.

Why arises

Mortality in cardiogenic shock reaches 80%. This is every 8 out of 10 people with this condition.

The most common cause of cardiogenic shock is myocardial infarction (left or right ventricle). However, other conditions can lead to shock:

  • severe pain syndrome with myocardial infarction – the cardiac choice is not reduced, refers to the redistributive type of shock;
  • polymorphic polytopic ventricular tachycardia (a large number of different forms of ventricular complexes are recorded on the cardiogram);
  • ventricular fibrillation – the presence of many impulses that do not lead to normal heart contraction:
  • cardiac tamponade – the presence of a large accumulation of fluid in the pericardium, which compresses the heart, preventing it from contracting normally;
  • acute valvular insufficiency – rupture of the valves with bacterial endocarditis;
  • rupture of aneurysm of the heart.

Classification

Clinical symptomsGrade I – relatively lightGrade II – moderateGrade III – Extremely Heavy
Duration3-5 hours5-10 hoursMore than 10 hours
Blood pressure (mmHg)90 / 50 – 60 / 4080 / 50 – 40 / 20Progressive drop in blood pressure
Heart rateModerate tachycardia (100 beats per minute).Average tachycardia (110-120 beats per minute).Severe tachycardia (over 120 beats per minute).
Circulating blood volumeReduced by 10-25%Reduced by 25-35%Reduced by more than 35%
ComplicationsHeart failure is absent, or weakly expressed.Heart failure in the acute phase.Alveolar pulmonary edema. Respiratory distress syndrome.
Response to drug therapyFast and steady.Slow and unstable.Unstable and short-term, or completely absent.

By the nature of the course, the following pathogenetic forms of cardiogenic shock are distinguished:

  1. Reflex shock (collapse) occurs as a reaction to pain. This form has a relatively mild course and is best amenable to therapy. In order to prevent the development of collapse and restore hemodynamics, vasopressor agents are used.
  2. Arrhythmic shock is caused by disturbances in the normal rhythm of cardiac activity and a malfunction in the functioning of the myocardial conducting system. The variants of the course of this form are determined by arrhythmic disturbances – pathological acceleration or, conversely, a slowdown in heart contractions per unit time. Sinus rhythm recovery occurs after normalization of the volume of cardiac output.
  3. True cardiogenic shock is a dangerous condition with an unfavorable prognosis for the number of deaths. The mechanism of the development of cardiocardium consists in the progressive damage of large areas of the heart muscle, which leads to the development of acute left ventricular failure and filling of the pulmonary alveoli with fluid (cardiogenic pulmonary edema).
  4. The reactive shock has a similar pathophysiology with true cardiogenic shock, more severe and prolonged in the nature of the course, as severe hemodynamic disturbances cannot be stopped even by special drugs.
  5. The shock caused by rupture of the myocardium is accompanied by a serious violation of the contractility of the heart muscle. Its pathogenesis will be determined by the nature of the gap (external or internal). External rupture of the myocardium leads to the accumulation of blood between the layers of the pericardium and prevents normal contractile movements. With an internal rupture, such heart structures as papillary muscles and interventricular septum are deformed.

Survival forecast

In a state of cardiogenic shock, the chances of survival directly depend on the degree of its severity and the time of the start of resuscitation. Unfortunately, the prognosis of survival is unfavorable: more than half of patients (70%) die in the first hours, 20% can live a couple of days, and only 10% of patients remain alive.

But even from this number only a few will return to their usual way of life, since irreversible lesions received in a state of cardiocardium are very serious. Mortality after shock occurs from progressive heart failure, thrombosis, recurrent heart attack or ischemic stroke, etc.

The main recommendation of doctors for people with pathologies that are at high risk of developing a heart attack (for example, arterial hypertension, vascular atherosclerosis, venous thrombosis, etc.) is lifestyle correction, complex treatment of the underlying disease and the prevention of complications with medications.

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.

Cardiogenic shock: symptoms, emergency care, causes, prevention

The clinical picture of cardiogenic shock is characterized by the following manifestations:

  • the skin turns pale, the nasolabial triangle acquires a characteristic color for circulatory disorders – gray or cyanotic;
  • cold limbs, increased sweating;
  • heartbeat is frequent (over 100 beats per minute), while the pulse is weak, filiform;
  • Blood pressure drops to critical levels – systolic below 90 mm. Hg. column, diastolic below 30 mm. Hg. pillar;
  • pulse pressure drop up to 20-25 mm. Hg. pillar and below;
  • decrease in body temperature (below 35,5 degrees);
  • when breathing, wheezing is heard, the nature of breathing is superficial;
  • a decrease in urine output to 20 ml per hour (oliguria) or a complete cessation of urination (anuria);
  • possible cough with foamy sputum;
  • pain is concentrated in the chest, extending to the upper shoulder girdle and arms;
  • complete loss of consciousness, coma, lethargy, sometimes this is preceded by a short period of excitement.

Symptoms of cardiogenic shock are associated with a violation in various parts of the blood circulation. When examining the patient, there is a sharp drop in pressure, lack of pulse when palpating the radial artery and a barely noticeable beating on the carotid artery.

The state of shock always develops at lightning speed, seconds are allocated for diagnosis. But experienced doctors of the ambulance team can always determine a cardiogenic stroke by the following characteristic symptoms.

The severity of cardiogenic stroke is evidenced by the duration of the condition and especially the reaction to the use of pressor amines. With a shock duration of more than six hours, poor response to medications and an increase in arrhythmia in combination with pulmonary edema, one can judge about reactive shock.

preventive 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 as calm as possible to 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.

Cardiogenic shock emergency recommendations

Diagnostics. A marked decrease in blood pressure in combination with signs of impaired blood supply to organs and tissues. Systolic blood pressure is usually below 90 mmHg. Art., pulse – below 20 mm RT. Art.

Symptoms of peripheral circulation deterioration (pale cyanotic moist skin, collapsed peripheral veins, decreased skin temperature of the hands and feet) are noted; decrease in blood flow velocity (time of the disappearance of a white spot after pressing on the nail bed or palm – more than 2 s), decreased diuresis (less than 20 ml / h), impaired consciousness (from mild inhibition to the appearance of focal neurological symptoms and the development of coma).

Differential diagnosis. In most cases, true cardiogenic shock should be differentiated from its other varieties (reflex, arrhythmic, drug, with a slow-flowing myocardial rupture, rupture of the septum or papillary muscles, damage to the right ventricle), as well as from pulmonary embolism, hypovolemia, internal bleeding and hypotension without shock.

Emergency care must be carried out in stages, quickly moving to the next stage with inefficiency
previous:
1. In the absence of severe stagnation in the lungs:
– lay the patient with lower extremities raised at an angle of 20g (with severe stagnation in the lungs – see “Pulmonary edema”);
– carry out oxygen therapy;

2. In the absence of marked stagnation in the lungs and a sign of a sharp increase in CVP:
– Introduce 200 ml of 0,9% sodium chloride solution intravenously by bed for 10 minutes under the control of blood pressure, respiratory rate, heart rate, auscultatory picture of the lungs and heart (if possible, control the CVP and jamming pressure in the pulmonary artery);

– with persistent arterial hypotension and the absence of signs of transfusion hypervolemia – repeat the introduction of fluid according to the same criteria;
– in the absence of signs of transfusion hypervolemia (CVP below 15 cm of water. Art.), Infusion therapy is continued at a rate of up to 500 ml / h, monitoring these indicators every 15 minutes.
If blood pressure cannot be stabilized quickly, then go to the next stage.

3. Introduce dopamine 200 mg in 400 ml of a 5% glucose solution intravenously, increasing the infusion rate from 5 μg / (kg X min) until a minimum sufficient blood pressure is reached;

– no effect – additionally prescribe norepinephrine gyrotartrate 4 mg in 200 ml of a 5% glucose solution intravenously, increasing the infusion rate from 0,5 μg / min until a minimum sufficient blood pressure is reached.

4. Monitor vital functions: cardiomonitor, pulse oximeter.

5. Hospitalize after a possible stabilization of the condition.

The main hazards and complications:
– untimely diagnosis and initiation of treatment;
– the inability to stabilize blood pressure;
– pulmonary edema with increased blood pressure or intravenous fluid;
– tachycardia, tachyarrhythmia, ventricular fibrillation;
– asystole;
– relapse of anginal pain;
– acute renal failure.

Note. By minimally sufficient blood pressure, systolic pressure of about 90 mm Hg should be understood. Art. with signs of improved perfusion of organs and tissues.

Glucocorticoid hormones in true cardiogenic shock are not indicated.

Although the results of the treatment of true cardiogenic shock remain unsatisfactory, intensive therapy must be persistently carried out in all (including the so-called hopeless!) Patients, starting from the prehospital stage.

Diagnostics. A marked decrease in blood pressure in combination with signs of impaired blood supply to organs and tissues. Systolic blood pressure is usually below 90 mmHg. Art., pulse – below 20 mm RT. Art.

Symptoms of peripheral circulation deterioration (pale cyanotic moist skin, collapsed peripheral veins, decreased skin temperature of the hands and feet) are noted; decrease in blood flow velocity (time of the disappearance of a white spot after pressing on the nail bed or palm – more than 2 s), decreased diuresis (less than 20 ml / h), impaired consciousness (from mild inhibition to the appearance of focal neurological symptoms and the development of coma).

Differential diagnosis. In most cases, true cardiogenic shock should be differentiated from its other varieties (reflex, arrhythmic, drug, with a slow-flowing myocardial rupture, rupture of the septum or papillary muscles, damage to the right ventricle), as well as from pulmonary embolism, hypovolemia, internal bleeding and hypotension without shock.

Emergency care must be carried out in stages, quickly moving to the next stage with inefficiency

– lay the patient with lower extremities raised at an angle of 20g (with severe stagnation in the lungs – see “Pulmonary edema”);

– with anginal pain, complete pain relief;

– carry out the correction of heart rate (paroxysmal tachyarrhythmia with CSF more than 150 strokes in 1 min – absolute indication for EIT, acute bradycardia with CSF less than 50 strokes in 1 min – for ECS);

– enter heparin 5000 IU intravenously.

– Introduce 200 ml of 0,9% sodium chloride solution intravenously by bed for 10 minutes under the control of blood pressure, respiratory rate, heart rate, auscultatory picture of the lungs and heart (if possible, control the CVP and jamming pressure in the pulmonary artery);

– with persistent arterial hypotension and the absence of signs of transfusion hypervolemia – repeat the introduction of fluid according to the same criteria;

– in the absence of signs of transfusion hypervolemia (CVP below 15 cm of water.

2 tbsp. ) infusion therapy is continued at a rate of up to 500 ml / h, monitoring these indicators every 15 minutes.

If blood pressure cannot be stabilized quickly, then go to the next stage.

3. Introduce dopamine 200 mg in 400 ml of a 5% glucose solution intravenously, increasing the infusion rate from 5 μg / (kg X min) until a minimum sufficient blood pressure is reached;

– no effect – additionally prescribe norepinephrine gyrotartrate 4 mg in 200 ml of a 5% glucose solution intravenously, increasing the infusion rate from 0,5 μg / min until a minimum sufficient blood pressure is reached.

4. Monitor vital functions: cardiomonitor, pulse oximeter.

5. Hospitalize after a possible stabilization of the condition.

– untimely diagnosis and initiation of treatment;

– the inability to stabilize blood pressure;

– pulmonary edema with increased blood pressure or intravenous fluid;

– tachycardia, tachyarrhythmia, ventricular fibrillation;

– relapse of anginal pain;

– acute renal failure.

Note. By minimally sufficient blood pressure, systolic pressure of about 90 mm Hg should be understood. Art. with signs of improved perfusion of organs and tissues.

Glucocorticoid hormones in true cardiogenic shock are not indicated.

Although the results of the treatment of true cardiogenic shock remain unsatisfactory, intensive therapy must be persistently carried out in all (including the so-called hopeless!) Patients, starting from the prehospital stage.

• regularly monitor the level of blood pressure;

• before prescribing antihypertensive therapy, perform a duplex scan of the main arteries of the head in patients with hypertension;

• prescribe regular antihypertensive therapy from the second day after the onset of stroke in patients with hypertension; individually select effective combinations and doses of antihypertensive drugs based on the results of daily monitoring of blood pressure (BPM) and control of subjective condition, gradually reduce blood pressure by 10/5 mm RT.

Art. below the initial level for 2-3 months ;.

• strive in the treatment of patients with hypertension to achieve the target level Blood pressure – less than 140/90 mm RT. Art.

In patients with a high and very high risk of cardiovascular complications, strive to lower blood pressure to 140/90 mm Hg. Art.

and less. In the future, subject to good tolerance, it is advisable to ensure a decrease in blood pressure to 130/80 mm RT.

Systolic blood pressure should not be reduced below 120 mm Hg. Art.

• avoid a rapid rate of decline in blood pressure in patients with occlusive or severe stenotic lesions of the main arteries of the head in order to reduce the risk of hemodynamic stroke;

• for control Blood pressure for primary and secondary prevention of acute cerebrovascular accidents, all classes of antihypertensive drugs and their rational combinations can be used at present.

represents the most proven area in the medical prevention of AI (recommendation class I, level of evidence A).

Unlike MI, the mechanisms of development of ischemic stroke are more diverse. To select an adequate ATT, it is necessary, first of all, to distinguish non-cardioembolic and cardioembolic variants of stroke.

A thrombus may form in situ with the gradual development of stenosis of the lumen of the vessel up to its occlusion, and enter the smaller vessels during atherothrombotic lesions of the large arteries of the head, aorta according to the type of arterial-arterial embolism, leading to the development of an atherothrombotic pathogenetic variant of AI.

In vessels with fast arterial blood flow, platelet-induced thrombogenesis is crucial. The reason for every sixth stroke is thromboembolism from the cavities of the heart, developing against the background of atrial fibrillation – a cardioembolic pathogenetic variant.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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