Cardiogenic shock is a rare condition .in this heart unable to pump an adequate amount of blood flow. types coronary cardiogenic shock and noncoronary cardiogenic shock.causes include any rupture of the in the ventricles .mi condition, any infectious condition,any medication that is a rare condition of the heart Are older Have a history of heart failure or heart attack Have blockages (coronary artery disease) in several of your heart's main arteries Have diabetes or high blood pressure Are female, Race or ethnicity Cardiogenic shock signs and symptoms include: Rapid breathing Severe shortness of breath Sudden, rapid heartbeat (tachycardia) Loss of consciousness Weak pulse Low blood pressure (hypotension) Sweating Pale skin Cold hands or feet Urinating less than normal or not at all treatment like emergency medication,dopamine ,doputamine ,adrenaline also given as a treatment to the patent. some other surgical procedure is there like cabg , heart transplantationmetc. preventionj oxf this avoid smoking,control alcohol,avoid stress etc -

1. CARDIOGENIC SHOCK
PRESENTED BY
R.PRIYA
PROFESSOR

2. INTRODUCTION
Cardiogenic shock (CS) is the most severe form of acute heart failure,
characterized by low cardiac output, hypotension, and systemic hypoperfusion. CS
is the leading cause of death in acute coronary syndrome (ACS) that accounts for
about 80% of CS cases.
CS complicates 5% to 10% of cases of acute MI and is the leading cause of death
after MI Higher incidences of CS are observed in women, Asian/Pacific Islanders,
and patients aged >75 years. While the in‐hospital mortality has improved, the 6‐
to 12‐month mortality in cardiogenic shock has remained unchanged at ≈50% over
the past 2 decades. Survivors of MI‐associated CS have an 18.6% risk of 30‐day
readmission after discharge, with a median time of 10 days. The risk of
readmission is slightly lower among patients with STEMI versus NSTEMI. The
most common causes of readmission are congestive heart failure and new
myocardial infarction. Female sex, low socioeconomic status, mechanical
circulatory support (MCS) device placement, atrial fibrillation, and ventricular
tachycardia are predictors of readmission.

3. DEFINITION
Cardiogenic shock is a life-threatening condition in which your heart suddenly
can't pump enough blood to meet your body's needs. The condition is most
often caused by a severe heart attack, but not everyone who has a heart attack
has cardiogenic shock. Cardiogenic shock is rare.

4. TYPES
1.Coronary: Coronary cardiogenic shock is more common than non-
coronary cardiogenic shock and is seen most often in patients with acute
myocardial infarction.
2.Non-coronary: Non-coronary cardiogenic shock is related to conditions
that stress the myocardium as well as conditions that result in an
ineffective myocardial function.

5. CAUSES
• Heart attack and other heart problems
A heart attack is the most common cause of cardiogenic shock. Cardiogenic shock
quickly when it follows a heart attack.
Heart attacks can damage the heart’s muscles and tissues and cause serious heart
lead to cardiogenic shock. These include:
•Papillary muscle infarction or rupture. The muscles that help anchor the heart valves
valves stop working or break when a heart attack cuts off their blood supply. If this
flow correctly between the heart’s chambers. The muscle infarction or rupture prevents
pumping properly.
•Ventricular septal rupture. Damage from a heart attack can cause the wall that
separates the ventricles , which are the heart’s two lower chambers, to break down.
separate them, the ventricles cannot pump properly.
Other heart conditions, such as heart failure or arrhymia , can reduce the heart’s ability
rich blood to your organs, leading to cardiogenic shock. Injuries that damage the heart
cardiogenic shock.
Inflammation plays an important role in cardiogenic shock.

6. CAUSES cont…
• Problems outside the heart
Cardiogenic shock can be caused by problems outside the heart, including fluid
causing cardiac tamponade, internal bleeding or blood loss, or pulmonary embolism,
thromboembolism. Trauma or injury to the chest can damage the heart so that it no
effectively. For example, injuries that bruise or put pressure on the heart can cause
• Medicines or procedures
Rarely, some medicines can cause cardiogenic shock if you take a dose that is too
is not working well after a heart attack or other heart problem. Examples include heart
as beta blockers or calcium channel blockers to treat high blood pressure. It is rare
cause cardiogenic shock, and you can lower your risk by taking the right doses of
time.
Very rarely, a heart procedure, such as cardiac catheterization, may injure the heart
arrhythmia, leading to cardiogenic shock.

7. RISK FACTORS
•Are older
•Have a history of heart failure or heart attack
•Have blockages (coronary artery disease) in several of your heart's main
arteries
•Have diabetes or high blood pressure
•Are female
• Race or ethnicity
- Cardiogenic Shock
Asian Americans and Pacific Islanders have a higher risk of cardiogenic shock than other
racial or ethnic groups.
Hispanics and African Americans are less likely than whites to receive emergency lifesaving
treatment to restore blood flow when they have cardiogenic shock.

9. SIGN AND SYMPTOMS
Cardiogenic shock signs and symptoms include:
•Rapid breathing
•Severe shortness of breath
•Sudden, rapid heartbeat (tachycardia)
•Loss of consciousness
•Weak pulse
•Low blood pressure (hypotension)
•Sweating
•Pale skin
•Cold hands or feet
•Urinating less than normal or not at all

10. DIANOSTIC EVALUTION
•Blood pressure measurement. People in shock have very low blood pressure.
•Electrocardiogram (ECG or EKG). This quick, noninvasive test records the
electrical activity of your heart using electrodes attached to your skin. If you have
damaged heart muscle or fluid buildup around your heart, the heart won't send
electrical signals normally.
•Chest X-ray. A chest X-ray shows the size and shape of your heart and whether
there's fluid in your lungs.
•Blood tests. You'll have blood drawn to check for organ damage, infection and heart
attack. An arterial blood gas test might be done to measure oxygen in your blood.
•Echocardiogram. Sound waves produce an image of your heart. This test can help
identify damage from a heart attack.
•Cardiac catheterization (angiogram). This test can reveal blocked or narrowed
arteries. A doctor inserts a long, thin tube (catheter) through an artery in your leg or
wrist and guides it to your heart. Dye flows through the catheter, making your arteries
more easily seen on X-ray.

11. CARDIAC CATHETARIZATION
A Swan-Ganz catheterization is a type of pulmonary artery catheterization procedure.
It’s a diagnostic test used to determine whether any hemodynamic, or blood flow-related, abnormalities
exist in the heart and lungs. It can be a useful test for people who have recently had heart problems,
such as a heart attack.
The procedure involves the insertion of a pulmonary artery catheter (PAC) into the right side of the
heart and into the arteries that lead to the lungs. The PAC has a balloon tip. The balloon allows the
catheter to be carried by the flow of your blood to the place in your heart where it’ll be used.
Because your blood takes the catheter where it’s needed, imaging isn’t needed to help guide it.
Therefore, the procedure can be done at your bedside. The PAC is also known as a Swan-Ganz
catheter, or right heart catheter.
The procedure itself is sometimes called right heart catheterization. This is because it can measure the
pressure of your blood as it flows through the right side of your heart. It measures the pressure at three
different places:
• Right atrium
•pulmonary artery
•pulmonary capillaries
These measurements can be used to figure out the amount of oxygen in the blood of the right portion
of your heart. It’s also used to figure out how much blood flows out of your heart overall.

12. TREATMENT
Cardiogenic shock treatment focuses on reducing the damage from lack of oxygen to your heart muscle and other
organs.
Emergency life support
Most people who have cardiogenic shock need extra oxygen. If necessary, you'll be connected to a breathing
machine (ventilator). You'll receive medications and fluid through an IV line in your arm.
Medications
Fluids and plasma are given through an IV. Medications to treat cardiogenic shock are given to increase your heart's
pumping ability and reduce the risk of blood clots.
•Vasopressors. These medications are used to treat low blood pressure. They include dopamine, epinephrine
(Adrenaline, Auvi-Q), norepinephrine (Levophed) and others.
•Inotropic agents. These medications, which help improve the pumping function of the heart, may be given until
other treatments start to work. They include dobutamine, dopamine and milrinone.
•Aspirin. Aspirin is usually given immediately to reduce blood clotting and keep blood moving through a narrowed
artery. Take an aspirin yourself while waiting for help to arrive only if your doctor has previously told you to do so for
symptoms of a heart attack.
•Antiplatelet medication. Emergency room doctors might give you drugs similar to aspirin to help prevent new
clots from forming. These medications include clopidogrel (Plavix), tirofiban (Aggrastat) and eptifibatide (Integrilin).
•Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood
less likely to form clots. IV or injectable heparin usually is given during the first few days after a heart attack.

13. MEDICAL PROCEDURE
Medical procedures to treat cardiogenic shock usually focus on restoring blood flow through
your heart. They include:
•Angioplasty and stenting. If a blockage is found during a cardiac catheterization, your doctor
can insert a long, thin tube (catheter) equipped with a special balloon through an artery, usually
in your leg, to a blocked artery in your heart. Once in position, the balloon is briefly inflated to
open the blockage.
A metal mesh stent might be inserted into the artery to keep it open over time. In most cases,
you doctor will place a stent coated with a slow-releasing medication to help keep your artery
open.
•Balloon pump. Your doctor inserts a balloon pump in the main artery off of your heart (aorta).
The pump inflates and deflates within the aorta, helping blood flow and taking some of the
workload off your heart.
•Extracorporeal membrane oxygenation (ECMO). ECMO helps improve blood flow and
supplies oxygen to the body. Blood is pumped outside of your body to a heart-lung machine
that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body.

14. SURGICAL PROCEDURE
If medications and other procedures don't work to treat cardiogenic shock, your doctor might
recommend surgery.
•Coronary artery bypass surgery. This surgery uses a healthy blood vessel in your leg, arm
or chest to create a new pathway for blood so it can flow around a blocked or narrowed artery.
Your doctor might suggest this surgery after your heart has had time to recover from your heart
attack. Occasionally, bypass surgery is done as an emergency treatment.
•Surgery to repair an injury to your heart. Sometimes an injury, such as a tear in one of your
heart's chambers or a damaged heart valve, can cause cardiogenic shock. Surgery might
correct the problem.
•Ventricular assist device (VAD). A mechanical device can be implanted into the abdomen
and attached to the heart to help it pump. A VAD might extend and improve the lives of some
people with end-stage heart failure who are waiting for new hearts or aren't able to have a
heart transplant.
•Heart transplant. If your heart is so damaged that no other treatments work, a heart
transplant may be a last resort.

15. COMPLICATION
•Cardiopulmonary arrest.
•Dysrhythmia.
•Renal failure.
•Multisystem organ failure.
•Ventricular aneurysm.
•Thromboembolic sequelae.
•Stroke.
•Death.

16. PREVENTION
•Don't smoke, and avoid secondhand smoke. If you smoke, the best way to reduce your heart
attack risk is to quit.
•Maintain a healthy weight. Being overweight contributes to other risk factors for heart attack and
cardiogenic shock, such as high blood pressure, cardiovascular disease and diabetes. Losing just 10
pounds (4.5 kilograms) can lower blood pressure and improve cholesterol levels.
•Eat less cholesterol and saturated fat. Limiting these, especially saturated fat, can reduce your risk
of heart disease. Avoid trans fats.
•Use less salt. Too much salt (sodium) leads to fluid buildup in the body, which can strain the heart.
Aim for less than 2,300 milligrams (mg) a day of sodium. Salt can be found in many canned and
processed goods, so it's a good idea to check food labels.
•Cut back on sugar. This will help you avoid nutrient-poor calories and help you maintain a healthy
weight.
•Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up
to one drink a day for women and up to two drinks a day for men.
•Exercise regularly. Exercise can lower your blood pressure and improve the overall health of your
blood vessels and heart. Get at least 150 minutes of moderate aerobic activity or 75 minutes of
vigorous aerobic activity a week, or a combination of moderate and vigorous activity. It's
recommended to spread out this exercise during the course of a week. Greater amounts of exercise
will provide even greater health benefits.
If you have a heart attack, quick action can help prevent cardiogenic shock. Seek emergency medical
help if you think you're having a heart attack.