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CARDIOGENIC SHOCK and ACUTE CARDIAC INSUFFICIENCY

- Definition
- A few explanations
- The symptoms, How to make the diagnosis?
- Management and Treatment
- The Other causes of a shock

THE OTHER CAUSES FOR A SHOCK

1 - The non cardiogenic shocks

a - The hypovolaemic shocks (reduction of the liquid volume in the organism) correspond to a loss...

-...of blood by an externalised haemorrhage or not (extra-uterine pregnancy, rupture of aneurysm, aortic dissection, haematoma...);

-...of salt with dehydration.

b - The vasoinhibitor shocks (corresponding to a reduction of the vessels tonus and therefore to their dilation) are in relation with:

- The anaphylactic shock (due to an allergy) whose main treatment is the injection of adrenaline;

- The neurogenic shock (due to the activation of some nerves);

- The septic shock (due to an infection).

2 - The other cardiogenic shocks

a - The mechanical complications of the myocardial infarction whose treatment is always surgical

- The intervention in the framework of a bleeding in the pericardium (haemopericardium) is the most urgent.

- In the rupture of the wall between the two ventricles, the treatment can sometimes be differed if the situation is stable so as not to operate any too friable tissues.

- In the acute mitral insufficiency, the replacement or the valvular reconstruction is also associated to a revascularisation.

b - Some cardiogenic shocks look like the post-infarct cardiogenic shock of the myocardium.

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During the dilation of the heart, the clinical context is different: there is no pain, no signs of myocardial infarction during the electrocardiogram, and the echocardiography objectivizes a global dilation of the 2 ventricles or only of the left ventricle.

In case of myocarditis (inflammation of the cardiac muscle), the clinical situation and the electrocardiogram can be misleading. A viral infectious context exists however and also very often a pericarditis (inflammation of the pericardium, the envelope surrounding the heart).

The most serious cases benefit from a circulatory aid in the waiting of a transplantation.

c - A cardiogenic shock can complicate the evolved aortic stricture and the infectious endocarditis: the diagnosis is assured by the cardiac ultrasound.

d - The disorders of the heart rhythm

A slowing of the heart frequency (bradycardia) can be responsible for a cardiogenic shock, in particular in a context of myocardial infarction.

e - The obstructive shocks

The most frequent cause of this type of shock is the tension pneumothorax, generally in the patient ventilated by a machine, which makes him breathe. The causes to suspect in the presence of an evocative context are the pulmonary embolism and the tamponade.

The occurrence of a clot on a valvular prosthesis can come with a cardiogenic shock and the treatment is surgical, except in the case of a mechanical prosthesis, which can benefit from a decomposition of the clot (thrombolysis).

f - The other causes of a heart failure

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File last reviewed on dec 18, 2011