Cardiogenic shock: pathophysiology and clinical management

Heart disease is one of the deadliest killers in the United States today. In its wide variety of forms it is always consistently destructive to the body, for the heart is one of the primary organs needed for basic survival. When the heart fails to pump enough blood and oxygen to the rest of the body, serious complications like cardiogenic shock can occur; cardiogenic shock being a serious complication with unnervingly high risks for mortality which grow with age and blood pressure.

There is a variety of different abnormal functions occurring during the onset of cardiogenic shock. When the shock hits, the heart cannot continue to pump at a normal rate. This leads to a lacking of oxygen in the various tissues of the body (O'Rourke et al. 2001). Additionally, cardiogenic shock has been known as a result of deficient nutrients. This all occurs even with the left ventricular artery working normally. The onset of cardiogenic shock can come from major complications associated with acute myocardial infraction (Wilansky & Willerson 2002). Additionally, research shows that "In those with extensive myocardial damage, mild-to-severe decreases in systematic arterial blood pressure occurs," resulting in cardiogenic shock (Wilanksy & Willerson 2002:74). When systematic blood pressure rises and there is a combined lack of appropriate levels of oxygen reaching the organs and extremities, cardiogenic shock can occur. Research also shows some severe cases of TR "that may result in cardiogenic shock is papillary muscle rupture after right ventricular infraction," (Willanksy & Willarson 2002:267). When the shock occurs, it is serious to act quickly to save the patient's life.

There are many symptoms and signs which are associated with cardiogenic shock. In many cases, the patient also exhibits Oliguria, which is a decrease in urination (O'Rourke 2001). Additionally, the extremities of the body drop in temperature and can get extremely cold due to lack of proper circulation levels. There are also sudden rushes alterations in normal cognitive functions. Patients have been known to exude signs of anxious and restless behavior. Fatigue and lapses in consciousness can also be ominous indicators. In the event of cardiogenic shock, there is an increase in respiration levels. According to research, roughly 77% of patients in cardiogenic shock will be at risk for entering a state of cardiac arrest (Jenicek 2002).

Intervening and managing cardiogenic shock depends highly on the rate the shock is attended to. In many cases, Inotropic agents, which help stop the chaos of muscle spasms. These medications can include but are not limited to Berberine and Bipyridine (including inamrinone, and milirinone). Additionally, boosts of Calcium and Dopamine have been known to provide favorable results in the middle of a case of cardiogenic shock. Other substances such as Dobutamine and Dopexamine are also effective.

Cardiogenic shock affects a wide range of patients, but there are some common patterns within its risk populations. It is typically associated with older populations of patients. According to the research, "The incidence of heart failure and cardiogenic shock is three-to-four-fold greater among the elderly than among younger infarct patients," (O'Rourke et al. 2001:44). Therefore, older populations are not only at a higher risk of cardiogenic shock, but they are also at a higher class of mortality rates. Yet, younger populations are not immune to cardiogenic shock in the event of other chronic cardiac diseses are present.

Today, there are several current management trends in the field. Properly managing cardiac failures during critical times can mean the difference. It is important to manage the situation as fast as possible, for the longer the patient stays in a state of cardiogenic shock, the higher the risk of mortality (Gottfried & Sloan 2002). One of the most used management strategies is a Coronary Artery Bypass Surgery (CABG). Yet even within this case context, mortality rates can range between 10 and 40%. However, effectively implementing the surgery can mean the difference between life and death. According to research, "These results are generally better than those associated with PCI," (O'Rourke et al. 2001:313). Emergency CABG surgeries are also more prominent in specific cases of cardiogenic shock. For instance, "AMI Patients with multivessel coronary artery disease or cardiogenic shock who have had unsuccessful thrombolysis and/or PTCA and are within 4 to 6 h of the onset of symptoms should be considered for emergency CABG," (O'Rourke et al. 2001:313). Since 1976, Thoretec VAD has been used to support patients with cardiogenic shock," (Willanksy & Willerson 2002:305). Inaarortic balloon pumping has also been used in cases of cardiogenic shock for decades within the modern medical practice context (Kantrowitze et al. 1968).