User:Mr. Ibrahem/Cardiogenic shock

Cardiogenic shock (CS) is a disorder of the heart that results in prolonged inadequate blood flow to the tissues of the body. The most common symptoms are altered mental status and clammy, bluish, or mottled skin. Swelling may be present in the legs. Complications may include kidney failure, respiratory failure, and stroke.

The most common cause is a heart attack. Other causes include valvular heart disease, aortic dissection, cardiomyopathy, myocarditis, arrhythmia, and beta blocker or calcium channel blocker overdose. Diagnosis involves a systolic blood pressure less than 90 mmHg and a urine output of less than 30 mL/hr or cool arms and legs. This occurs despite sufficient volume in the blood vessels. Cardiac tamponade and pulmonary embolism are generally deemed to be causes of obstructive shock.

The initial goal of treatment is to raise the blood pressure, support breathing, and reverse any underlying causes. This may include intravenous fluids and vasopressors such as norepinephrine or dobutamine. A central line and arterial line may be useful for giving medications and monitoring the condition. If the underlying cause is a heart attack, primary percutaneous coronary intervention (PCI) is recommended. Other efforts may include extracorporeal membrane oxygenation (ECMO), ventricular assist device (VAD), or heart transplant. Mechanical ventilation or dialysis may also be required. Palliative care may be useful in certain cases.

Cardiogenic shock affects about 7% of STEMIs and 3% of NSTEMIs. It is becoming less common with the greater use of primary percutaneous coronary intervention (PCI) for heart attacks. Poor outcomes are common, with a 30% to 80% risk of death. The condition was first described in 1912 by Herrick; however, the current name for the condition did not come into use until 1942.