Cardiogenic shock is defined now as hypoperfusion of fabrics which is caused by heart failure and is not eliminated by correction of preloading. This rather frequent state in an intensive care which is followed by the high lethality and high level of complications among the survived patients.
The acute left ventricular failure is defined as the respiratory distress connected with falling of warm emission, increase in an afterload or change of permeability of an alveolocapillary membrane. The fluid lungs is clinical manifestation of an acute left ventricular failure which is divided into two views (stage): intersticial and alveolar.
The etiology of cardiogenic shock includes various pathology of heart connected with falling of warm emission, most often — a myocardial infarction.
The clinical picture of cardiogenic shock includes arterial hypotension, hypoperfusion of fabrics and rather often the clinic of an acute left ventricular failure joins it.
At a myocardial infarction allocate a concept of reflex cardiogenic shock, aritmogenny cardiogenic shock and true cardiogenic shock. Reflex cardiogenic shock at a myocardial infarction often is connected with insufficient quality of anesthesia of the patient. Also in certain cases allocate so-called artimonenny shock when this or that arrhythmia caused by a myocardial infarction is the cornerstone of hypoperfusion. Understand the condition of hypoperfusion which is initially connected with decrease in sokratitelny ability of a myocardium as true cardiogenic shock.
The clinical picture, respectively, will be based on what type of shock takes place. In case of reflex shock on the first place the expressed koronarogenny pain syndrome and the hypotension accompanying it and hypoperfusion will act. In case of aritmogenny shock the clinical picture will be is the cornerstone by disturbance of a heart rhythm with hypotension and clinic of a depressed case. In case of true cardiogenic shock the most serious condition of patients is noted, as a rule, and to the forefront there are arterial hypotension and symptoms of hypoperfusion here (consciousness disturbances, pallor of integuments, decrease in a diuresis and so on). The clinical picture can be complemented with development of an acute left ventricular failure as an intersticial or alveolar fluid lungs.
The list of methods of laboratory and tool diagnostics at inspection of the patient with cardiogenic shock includes an electrocardiography, a X-ray analysis of bodies of a thorax, a computer tomography (diagnostics of a thromboembolism of a pulmonary artery or focal changes in lungs), an echocardiography for assessment of contractility of a myocardium, functioning of the valve device, an exudate in a cavity of a pericardium and other pathology. Surely conduct laboratory blood analyses. According to indications the coronary angiography which gives the chance to execute myocardium revascularization in those cases is carried out when it is shown and possible.
Monitoring when maintaining the patient with cardiogenic shock shall include noninvasive monitoring of arterial blood pressure, EGK, respiration rate, a pulsoksimetriya. Installation of the arterial line for monitoring of invasive arterial blood pressure and sampling for carrying out the analysis of KShchS and gases of an arterial blood is desirable. Usually installation of the central venous catheter for monitoring of TsVD, administration of vasoactive and inotropic drugs is required. According to indications catheterization of a pulmonary artery can be executed by a catheter of Svan-Gantsa.
Treatment of cardiogenic shock represents a difficult task, especially if it is about its true option. Reflex shock is often stopped after adequate anesthesia (under cover of angiotonic and inotropic support), aritmogenny demands elimination of the arrhythmia which caused it. At true cardiogenic shock correction of the reason which caused this state is very important. Revascularization — essentially important action at cardiogenic the shock caused by a myocardial infarction.
To patients with an anoxemia the oxygenotherapy is appointed, if necessary begin noninvasive or traditional artificial ventilation of the lungs. For maintenance of a system hemodynamics inotropic support is carried out.
According to indications use mechanical support of blood circulation: intra aortal balloon counterpulsation, left ventricular round (LVAD), or extracorporal membrane oxygenation.