Emergency care for cardiogenic shock: an algorithm of action. Resuscitation emergency team

Acute cardiovascular failure refers to life-threatening conditions. By the mechanism of development, it is divided into right and left ventricular OCH. Both these conditions often result in death. To save a person, an ambulance must immediately begin resuscitation.

Most often there is left ventricular heart failure. It usually follows myocardial infarction, severe rhythm disturbances and other dangerous conditions. To the types of OSS include acute cardiogenic shock. It is caused by severe lesions for the body, in which the heart can not pump blood in the normal regime.

The concept of cardiogenic shock

Emergency care for cardiogenic shock is necessary in the first minutes of its development. It should be remembered that this complication will not pass by itself. And in the absence of urgent treatment will lead to death. Cardiogenic shock is a syndrome in which cardiac output decreases. Despite the compensatory increase in vascular resistance, the body can not cope with this complication without the help of doctors.

Its main manifestations include lowering of arterial and pulse pressure, diuresis, loss of consciousness. If assistance is not provided in time, death from cardiogenic shock occurs within a few hours after the development of the disease. This state does not arise on its own. He is always preceded by acute pathologies of the cardiovascular system.

What causes lead to cardiogenic shock?

The causes of heart shock include various cardiac and vascular diseases. The most common etiological factor is myocardial infarction. At the same time cardiogenic shock develops only with massive tissue necrosis and lack of first aid. Also to frequent causes of its occurrence are life threatening arrhythmias. They can bother a person for many years. But with their aggravation and decompensation, these conditions are complicated by shock.

In some cases, the development of acute heart failure is a violation of vascular tone. This happens with massive bleeding, pain syndrome, arthritis. It must be remembered that cardiogenic shock is not an independent disease, but a complication of the underlying pathology. Therefore, doctors need to do everything to prevent its development.

Cardiogenic shock: classification of the disease

Depending on the cause and pathogenesis, several forms of cardiogenic shock are distinguished. Each of them has its own development mechanism. Nevertheless, all variants lead to the same symptoms. Regardless of the cause of its appearance, emergency care for cardiogenic shock is necessary in any case. Since this state is always equally dangerous. There are following types of this complication:

1. True cardiogenic shock. It develops when the tissue of the heart is damaged. In most cases this form is caused by transmural myocardial necrosis.
2. Arrhythmic shock. To its causes include fibrillation and flutter of the ventricles, extrasystole, severe bradycardia. In addition to arrhythmias, shock can lead to a violation of conduction of the heart.
3. Reflex cardiogenic shock. In this variant, the violation of the functions of the heart does not precede the complication. Usually it develops with massive blood loss, kidney failure.
4. AREA shock. Is the most dangerous option. It is isolated in a separate group, since it almost always leads to death and does not respond to treatment.

True cardiogenic shock: the mechanism of development

True heart shock is more common. It occurs if the majority of the myocardium is affected (from 50% or more). In this case, necrosis extends not only throughout the muscle thickness, but also occupies a large area. In addition to heart attack, other diseases can lead to a true shock. Among them: septic endocarditis, severe heart defects, decompensated myodystrophy, etc. Also, severe cardiac disorders include acute hyperthyroidism, some genetic pathologies.

As a result of necrosis of the heart tissues, the contractility significantly decreases. Therefore, the body can not work in full force and provide blood vessels. The minute volume also decreases. This increases the resistance of blood vessels. Despite this, the heart still does not cope with their work. The result is a disturbed blood supply to all organs and tissues.

Pathogenesis of arrhythmic cardiogenic shock

At the heart of this form of the disease are violations of conduction and rhythm of the heart. They can arise as spontaneously (as a result of myocardial infarction), and develop gradually. Most often, arrhythmias trouble the patient for many years. The same applies to conduction disorders. Nevertheless, life-threatening conditions develop within a short period. It's about hours and even minutes. Most often, cardiogenic shock is caused by violations of the rhythm of the ventricular nature. Among them: tachycardia, turning into fibrillation, and flutter. In addition, these processes can lead to frequent group extrasystoles.

Another condition that can lead to shock, is a sinus bradycardia. The decrease in heart rate is usually characterized by conduction disorders. Less often, cardiogenic shock leads to fibrillation and atrial flutter. As a result of pathological contractions and ectopic foci in the myocardium (extrasystoles), the heart can not perform its function. Therefore, there is a decrease in the impact and minute volume, the drop in pulse pressure, blood pressure. With this option, an ambulance first thing is to stop the arrhythmia by defibrillation or artificial heart massage.

What is a reflex shock?

This form of shock develops due to reasons not originally associated with defeat of the heart muscle. The trigger mechanism for such a complication can be severe pain syndrome or bleeding. However, these symptoms are rarely associated with the heart. Usually such a shock is diagnosed after an accident, acute renal failure.

This option has the most favorable forecast. Emergency care for a cardiogenic shock of a reflex character should be aimed at eliminating its cause - pain syndrome, as well as stop bleeding. Due to these factors, the regulation of vascular tone is impaired. Because of this, the blood stagnates in the veins and arteries, and the fluid penetrates into the interstitial space, forming an edema. All this leads to a decrease in the venous influx to the heart. Further, the mechanism is the same as in other forms.

The causes and pathogenesis of an arecative shock

Arising cardiogenic shock occurs if the entire myocardium is affected. This occurs with repeated heart attacks. Tamponade of the heart can also be the cause. In this case, a liquid appears in the pericardium, which squeezes the organ, preventing it from contracting. In some cases, tamponade can lead to heart rupture. This condition leads to death. Unfortunately, the patient can not be helped in this case. The mechanism of development of shock is associated with the complete cessation of the work of the heart, in contrast to other forms in which the minute volume decreases. Mortality from this complication is close to 100%.

Symptoms of cardiogenic shock

The clinical picture is the same, regardless of the cause of the cardiogenic shock. Symptoms of complications are as follows: a drop in arterial and pulse pressure, tachycardia, oliguria (a decrease in diuresis). Depending on the value of blood pressure and clinical data, 3 degrees of severity are distinguished. When examining the patient, you can identify other signs of cardiogenic shock. These include:

1. Cold and sticky sweat.
2. Fear of death or lack of consciousness.
3. Cyanosis - cyanosis of the skin.
4. The facial features of the patient can be pointed, facial expressions - suffering.
5. The color of the skin at a serious degree acquires a gray tinge.

How to diagnose a shock?

Diagnosis of cardiogenic shock is usually based on clinical data and the questioning of the patient's relatives. Since it is necessary to act immediately, doctors evaluate blood pressure, skin condition, pupil response, heart rate and respiratory rate. If the patient has signs of shock, immediate help is immediately available.

In the presence of free medical personnel, an anamnesis of the disease is revealed. The doctor asks: did the patient suffer from arrhythmia, angina pectoris, possibly, suffered a myocardial infarction earlier? If the complication develops at home or in the street, then the diagnosis of shock by ambulance doctors ends here. When the patient is kept in the intensive care unit, in addition, pulse pressure, vascular resistance, diuresis are measured. The gas composition of the blood is also investigated.

Cardiogenic shock: first aid, algorithm of actions

It is worth remembering that the life of the patient depends on how quickly and qualitatively the help is rendered. With signs of this complication, doctors start taking immediate action. If you do everything in time, you can defeat cardiogenic shock. Emergency help - the algorithm of actions is as follows:

1. Lay the patient in a horizontal position with an elevated foot end. In addition, it is necessary to provide access to the air (unfasten clothes, open the window).
2. Supply of oxygen. It can be carried out through a special mask or nasal catheter.
3. Anesthesia. With myocardial infarction and reflex shock, narcotic drugs are used for this. Most often, the drug "Morphine" is used. He is bred in physiological saline and injected / in slowly.
4. Recovery of BCC and blood flow. For this purpose, the solution is "Reopoliglyukin".
5. If there is no effect, it is necessary to raise blood pressure with the help of the drug "Atropine" 0.1%. Enter in an amount of 0.5-1 ml.

In addition, it is necessary to eliminate the cause of the shock. With myocardial infarction, thrombolytic and antiplatelet therapy is administered (preparations of Alteplase, Clopidogrel, Aspirin). Also for dilution of blood use a solution of "Heparin". With ventricular rhythm disturbances, the medication "Lidocaine" is administered. In some cases, defibrillation is necessary.

Emergency care in a hospital

Emergency care for cardiogenic shock continues in the intensive care unit. There is intensive therapy, constant monitoring of indicators, the causes of complications are clarified. With myocardial infarction, surgical treatment is performed - bypassing the arteries, establishing a stent. Also, surgical care is needed for certain arrhythmia and conduction disorders. At the same time, an artificial pacemaker is installed that performs the contractile function of the heart.