Cardiogenic shock history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Syed Musadiq Ali M.B.B.S.[3]
Overview
The presenting symptoms of cardiogenic shock are variable. The most common clinical manifestations of shock, such as hypotension, altered mental status, oliguria, and cold, clammy skin, can be seen in patients with cardiogenic shock. History plays a very important role in understanding the etiology of the shock and thus helps in the management of cardiogenic shock.The patient should also be assessed for cardiac risk factors: Diabetes mellitus, Tobacco smoking, Hypertension, Hyperlipidemia, A family history of premature coronary artery disease, Age older than 45 in men and older than 55 in women, Physical inactivity.
History and Symptoms
- Cardiogenic shock may be a complication of different conditions. Despite a common pattern of symptoms, each condition may have its specific history and presentation. Irrespective to the form of shock, most patients will commonly present with:
- Chest pain
- Respiratory distress due to possible pulmonary congestion
- Anxiety, confusion and agitation
- Fatigue, due to the work of breathing and hypoxia
- Manifestations of hypoperfusion:
- Altered mental status, possibly including flacid coma due to decreased cerebral perfusion and ensuing hypoxia
- Hypotension
- Oliguria
- Cool extremities
- Clammy skin
- Blood results with evidence of lactic acidosis
- The patient may present these symptoms immediately after the myocardial infarction, therefore manifesting them on admission, or as happens in most cases, develop them later during hospital admission.[1][2][3]
- These patients tend to evolve slowly into shock, first experiencing a decrease in cardiac output before hypotension is installed.
- This delay is thought to be due either to the failure of the compensatory mechanisms, that were initially protecting the body against the hemodynamic repercussions of MI or, to a possible reinfarction or occurrence of mechanical complications.
- The diagnosis of cardiogenic shock may be suspected from the clinical manifestations described above, aided by elements such as blood pressure, EKG and chest x-ray.
- Because of the urgency of starting treatment for this condition, due to the otherwise catastrophic outcome, the diagnostic procedures must be carried out along with resuscitative efforts.
References
- ↑ Babaev A, Frederick PD, Pasta DJ, Every N, Sichrovsky T, Hochman JS; et al. (2005). "Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock". JAMA. 294 (4): 448–54. doi:10.1001/jama.294.4.448. PMID 16046651.
- ↑ Holmes DR, Bates ER, Kleiman NS, Sadowski Z, Horgan JH, Morris DC; et al. (1995). "Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries". J Am Coll Cardiol. 26 (3): 668–74. PMID 7642857.
- ↑ Webb JG, Sleeper LA, Buller CE, Boland J, Palazzo A, Buller E; et al. (2000). "Implications of the timing of onset of cardiogenic shock after acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?". J Am Coll Cardiol. 36 (3 Suppl A): 1084–90. PMID 10985709.