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It occurs when the heart can not pump enough blood to generate adequate cardiac output and maintain normal blood pressure.

This occurs frequently in the context of a large myocardial infarction, however, other causes include acute valvular regurgitation, nonischemic cardiomyopathies and arrhythmia .

One of the life-threatening complications of acute myocardial infarction is cardiogenic shock, during which hypotension occurs due to low cardiac output.

What results in a hypoperfusion of terminal organs and a multisystem organic failure that can be fatal.

In this context, revascularization is recommended through coronary artery bypass surgery and percutaneous coronary intervention.

Hemodynamic support may also be necessary.

Causes

Cardiogenic shock occurs if the heart suddenly can not pump enough oxygen-rich blood to the body.

The most common causes are serious heart conditions.

Heart attack:

Many of these occur during or after a heart attack or myocardial infarction.

These complications include:

The most common cause of a cardiogenic shock is the damage to the heart muscle after a severe heart attack.

When a large section of heart muscle no longer moves well or does not move at all, when there is a rupture of the heart muscle due to damage from a previous heart attack.

  1.  Ventricular septal rupture: This condition occurs when the wall between the two ventricles or the lower chambers of the heart is damaged. This collapse occurs when the cells on the wall have died as a result of a heart attack.
  2. Papillary muscle rupture: This condition occurs if the muscles that help anchor the heart valves stop working or break because a heart attack interrupts the blood supply. If this happens, the blood does not flow properly between the chambers of the heart.

These damages make it impossible for the pumping chambers of the heart to function properly, causing the heart to not be able to pump blood properly to the lungs, where oxygen is collected and then returned to the heart and then to the rest of the body.

When there is not enough oxygen-rich blood to reach the organs of the human body, these complications can occur:

The cardiogenic shock can cause death if the blood flow rich in oxygen to the organs is not restored quickly. And this requires emergency medical treatment.

If organs do not get enough oxygen-rich blood, they will not work well. The cells of the organs die and it is likely that the organs will never function properly again.

When the organs stop working, complications can arise with other functions such as:

  • A malfunction of the kidneys, causes abnormal levels of chemicals in the blood, can cause heart and other muscle weakness, further limiting blood flow.
  • A malfunction of the liver, causes the body to stop producing proteins that help in the process of blood clotting. This can cause an increase in bleeding, if the cardiogenic shock is caused by blood loss.

The less time the patient stays in shock, the less damage to the organs.

This is one reason why emergency treatment is important.

 The presence of other heart conditions:

Serious heart conditions that can occur with or without a heart attack and can cause cardiogenic shock can be:

  • Myocarditis : is the inflammation of the heart muscle.
  • Endocarditis : It is an infection in the inner lining of the valves and chambers of the heart.
  • Life-threatening arrhythmias: As in the case of ventricular tachycardia, ventricular fibrillation or supraventricular tachycardia . These are problems that occur with heart rate or frequency.
  • Pericardial tamponade: The presence of too much fluid or blood around the heart. This fluid presses on the muscle of the heart which does not allow the correct pumping of the blood.
  • Very slow heart rate (bradycardia): There may also be problems with the electrical system of the heart (heart block).

Another cause of cardiogenic shock is the occurrence of a pulmonary embolism:

This is a sudden blockage in a pulmonary artery, it is a condition caused by a blood clot that travels to the lung and from there to the heart, when a thrombus forms in a vein in the leg, being able to cause a decrease in the blood pumping of the heart to other organs in the body.

Risk factor’s

Having a heart attack is the most common risk factor for cardiogenic shock. If you suffered a heart attack, the following factors can further increase your risk of cardiogenic shock:

  • To have an advanced age
  • Possess a history of heart failure.
  • Having coronary heart disease that affects all the major blood vessels of the heart.
  • Suffer from blood pressure problems.
  • Having diabetes

Among patients suffering from heart attacks, women have a higher risk of cardiogenic shock than men.

symptom

Some of the typical signs and symptoms of cardiogenic shock generally include the following:

  • Present confusion, lack of alertness or a general mental state decreased.
  • Presence of pain or pressure in the chest.
  • The loss of consciousness
  • The appearance of a sudden and continuous rapid heart rate.
  • Present excessive perspiration
  • Appearance of a pale color on the skin.
  • Change to a fast pulse.
  • A rapid breathing is presented.
  • Decrease or absence of urine production.
  • Presence of cold hands and feet.
  • Suffer from restlessness and agitation.
  • Presenting breathing difficulties.

Diagnosis

Tests and procedures to diagnose the shock and its underlying causes:

Blood pressure test:

Blood pressure is one of the most common signs of cardiogenic shock.

Electrocardiogram :

An electrocardiogram is a simple test that shows the electrical activity of the heart.

This test shows how fast the heart beats and its rhythm, strength and time of electrical signals.

It is used to diagnose severe heart attacks and monitor the state of the heart.

Echocardiography:

Echocardiography uses sound waves to produce a moving image of the heart.

This test provides information about the dimensions of the heart, the functioning of the heart’s chambers and valves, identifying areas where blood flow is deficient in the heart.

As well as areas of the heart muscle that fail to contract normally and injuries that exist in the heart muscle that are caused by poor blood flow.

Chest x-ray:

The chest x-ray shows images of organs such as the heart, lungs, and blood vessels.

This test can show the size of the heart, the presence of fluid in the lungs, which can be signs of cardiogenic shock.

Coronary angiography:

Coronary angiography is an examination of the heart and blood vessels with x-rays, where a contrast is passed through a thin, flexible catheter, through an artery from the leg or arm to the heart.

This catheter measures the pressure that exists within the chambers of the heart.

The contrast shows the images and allows to study the flow of blood that passes through the heart and blood vessels and see where the blockages are located.

Catheterization of the Pulmonary Artery:

To perform this procedure, a catheter is inserted into a vein in the arm or neck or near the clavicle.

Then, the catheter moves to the pulmonary artery.

This pulmonary artery connects the lungs to the right side of the heart.

The catheter is used to control blood pressure in the pulmonary artery.

Blood test:

Some blood tests are also used to help diagnose cardiogenic shock, including:

Measurement of arterial gases:

In this test, the blood sample is taken from an artery. This test is used to quantify the levels of oxygen, carbon dioxide and pH (acidity) in the blood, since certain levels of these substances are associated with cardiogenic shock.

The test of cardiac enzymes:

Dead cells in the heart release enzymes in the blood. These enzymes are called markers or biomarkers. The laboratory measurement of these markers in blood can show the damage and the magnitude of these damages in the heart.

Tests to know the function of organs, like the kidneys and the liver:

If these organs do not work well, they probably do not receive enough oxygen-rich blood and they will have abnormal levels, which could be signs of cardiogenic shock.

Treatment

Cardiogenic shock requires emergency medical treatment.

This condition is usually diagnosed after the patient has been admitted in emergencies due to a heart attack.

The fundamental goal of an emergency treatment to treat cardiogenic shock is to correct the flow of blood and oxygen from the heart to the organs of the body.

It is probable that both the cardiogenic shock and the cause that caused it will be treated at the same time.

Doctors can quickly treat a blocked blood vessel in the heart to remove the patient from the shock with the help of little or no additional treatment.

Among the therapies used to treat a cardiogenic shock we have:

Emergency life support:

The main emergency life support treatment, which must be performed in the event of any kind of shock.

This treatment helps restore the flow of oxygen-rich blood to the brain, kidneys and other organs, keeping the patient alive and preventing further damage to the organs.

This treatment includes: Providing the patient with extra oxygen, to get more oxygen to the lungs, the heart and the rest of the body and to provide respiratory support, if necessary, to protect the respiratory tract.

Medicines:

It may be necessary to use medications to increase blood pressure and improve cardiac function, correct the primary etiology and hemodynamic support with cardiac inotropes, these medications include:

The therapy to be used to treat cardiogenic shock will depend on its cause.

So these medications can be oriented to:

  • Avoid the formation of blood clots.
  • Increase the strength with which the heart muscle contracts.
  • Treat a heart attack

Medical devices:

Medical devices can help the heart pump and improve blood flow.

Among the most used devices can include:

The intraaortic balloon pump: This device is placed in the descending aorta artery, which is the main blood vessel that carries blood from the heart to the rest of the body.

The balloon allows more blood to flow to the heart and the weakened heart muscle can pump as much blood as possible, which makes it easier for blood to reach vital organs, such as the brain and kidneys.

The left ventricular assist device: It is a permanent circulatory mechanical assistance device, which is operated by a battery that is connected directly to the lower part of the left ventricle of the heart.

This is responsible for sucking the blood full of oxygen that enters the heart and enters the aorta. And from there the pumping action of the heart to the body takes place. This device is used if the damage that is causing the shock is due to the deficiency of the left ventricle, located in the main pumping chamber of the heart.

Procedures and surgery:

It is used when the administration of medications and the implantation of medical devices are not sufficient for the treatment of a cardiogenic shock.

Procedures and surgery can restore blood flow in the heart and in the rest of the body, can also repair these heart damages and can keep the patient while recovering from cardiogenic shock.

The procedures and surgery used to treat the underlying causes of cardiogenic shock include:

Percutaneous coronary intervention and stenting: This procedure is also known as coronary angioplasty and is a procedure used to open the coronary arteries that are narrowed or blocked.

The stent is an endoprosthesis, a small tube-shaped mesh that is placed in a coronary artery during percutaneous coronary intervention to help keep the coronary artery open.

Coronary revascularization graft: In this surgery, arteries or veins are taken from other parts of the body and used for revascularization or bypass around the blocked area of ​​the coronary arteries, creating a new passage for oxygen-rich blood get to the heart.

Heart transplant: This type of surgery is performed after the occurrence of a cardiogenic shock. Physicians must perform tests to make sure that the patient can benefit from a heart transplant, in addition to the proper tests of donor matching in a transplant.

Doctors can recommend a transplant surgery if they consider it a way to optimize a patient’s chances of long-term survival.

Other surgeries: Surgeries are performed to repair damaged heart valves or to repair a cut that has occurred in the wall that separates the two ventricles or lower chambers of the heart. This rupture is called septal rupture.