Cardiogenic shock

Cardiogenic shock is when the heart has been damaged so much that it is unable to supply enough blood to the organs of the body.

Causes

The most common causes are serious heart conditions. Many of these occur during or after a heart attack (myocardial infarction). These complications include:

• A large section of heart muscle that no longer moves well or does not move at all
• Breaking open (rupture) of the heart muscle due to damage from the heart attack
• Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia
• Pressure on the heart due to a buildup of fluid around it (pericardial tamponade)
• Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve
• Tear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers)
• Very slow heart rhythm (bradycardia) or problem with the electrical system of the heart (heart block)

Cardiogenic shock occurs when the heart is unable to pump as much blood as the body needs. It can happen even if there hasn't been a heart attack if 1 of these problems occurs and your heart function drops suddenly.

Symptoms

Symptoms include:

• Chest pain or pressure
• Coma
• Decreased urination
• Fast breathing
• Fast pulse
• Heavy sweating, moist skin
• Lightheadedness
• Loss of alertness and ability to concentrate
• Restlessness, agitation, confusion
• Shortness of breath
• Skin that feels cool to the touch
• Pale skin color or blotchy skin
• Weak (thready) pulse

Exams and Tests

An exam will show:

• Low blood pressure (most often less than 90 systolic)
• Blood pressure that drops more than 10 points when you stand up after lying down (orthostatic hypotension)
• Weak (thready) pulse

To diagnose cardiogenic shock, a catheter (tube) may be placed in the lung artery (right heart catheterization). Tests may show that blood is backing up into the lungs and the heart is not pumping well.

Tests include:

• Cardiac catheterization
• Chest x-ray
• Coronary angiography
• Echocardiogram
• Electrocardiogram
• Nuclear scan of the heart

Other studies may be done to find out why the heart is not working properly.

Lab tests include:

• Arterial blood gas
• Blood chemistry (chem-7, chem-20, electrolytes)
• Cardiac enzymes (troponin, CKMB)
• Complete blood count (CBC)
• Thyroid stimulating hormone (TSH)

Treatment

Cardiogenic shock is a medical emergency. You will need to stay in the hospital, most often in the Intensive Care Unit (ICU). The goal of treatment is to find and treat the cause of shock to save your life.

You may need medicines to increase blood pressure and improve heart function, including:

• Dobutamine
• Dopamine
• Epinephrine
• Levosimendan
• Milrinone
• Norepinephrine

These medicines may help in the short-term. They are not often used for a long time.

When a heart rhythm disturbance (dysrhythmia) is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include:

• Electrical "shock" therapy (defibrillation or cardioversion)
• Implanting a temporary pacemaker
• Medicines given through a vein (IV)

You may also receive:

• Pain medicine
• Oxygen
• Fluids, blood, and blood products through a vein (IV)

Other treatments for shock may include:

• Cardiac catheterization with coronary angioplasty and stenting
• Heart monitoring to guide treatment
• Heart surgery (coronary artery bypass surgery, heart valve replacement, left ventricular assist device)
• Intra-aortic balloon counterpulsation (IABP) to help the heart work better
• Pacemaker
• Ventricular assist device or other mechanical support

Outlook (Prognosis)

In the past, the death rate from cardiogenic shock ranged from 80% to 90%. In more recent studies, this rate has decreased to 50% to 75%.

When cardiogenic shock is not treated, the outlook is poor.

Possible Complications

Complications may include:

• Brain damage
• Kidney damage
• Liver damage

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of cardiogenic shock. Cardiogenic shock is a medical emergency.

Prevention

You may reduce the risk of developing cardiogenic shock by:

• Quickly treating its cause (such as heart attack or heart valve problem)
• Preventing and treating the risk factors for heart disease, such as diabetes, high blood pressure, high cholesterol and triglycerides, or tobacco use

Alternative Names

Shock - cardiogenic

Read More

Rheumatic fever

Rheumatic fever is a disease that may develop after an infection with group A streptococcus bacteria (such as strep throat or scarlet fever). It can cause severe illness in the heart, joints, skin, and brain.

Causes

Rheumatic fever is still common in countries that have a lot of poverty and poor health systems. It does not often occur in the United States and other developed countries. When rheumatic fever does occur in the United States, it is most often in small outbreaks. The latest outbreak in the United States was in the 1980s.

Rheumatic fever occurs after infections with a germ or bacteria called Streptococcus pyogenes or group A streptococcus. This germ appears to trick the immune system into attacking healthy tissues in the body. These tissues become swollen or inflamed.

This abnormal reaction seems to almost always occur with strep throat or scarlet fever. Strep infections that involve other parts of the body do not seem to trigger rheumatic fever.

Symptoms

Rheumatic fever mainly affects children ages 5 to 15 who have had strep throat or scarlet fever. If it occurs, it develops about 14 to 28 days after these illnesses.

Symptoms can affect many systems in the body. General symptoms may include:

• Fever
• Nosebleeds
• Pain in the abdomen
• Heart problems, which may have no symptoms, or may lead to shortness of breath and chest pain

Symptoms in the joints can:

• Cause pain, swelling, redness, and warmth
• Mainly occur in the knees, elbows, ankles, and wrists
• Change or move from one joint to another

Skin changes may also occur, such as:

• Ring-shaped or snake-like skin rash on the trunk and upper part of the arms or legs
• Skin lumps or nodules

A condition that affects the brain and nervous system, called sydenham chorea can also occur. Symptoms of this condition are:

• Loss of control of emotions, with bouts of unusual crying or laughing
• Quick, jerky movements that mainly affect the face, feet, and hands

Exams and Tests

Your health care provider will examine you and will carefully check your heart sounds, skin, and joints.

Tests may include:

• Blood test for repeated strep infection (such as an ASO test)
• Complete blood count (CBC)
• Electrocardiogram (EKG)
• Sedimentation rate (ESR -- a test that measures inflammation in the body)

Several factors called major and minor criteria have been developed to help diagnose rheumatic fever in a standard way.

The major criteria for diagnosis include:

• Arthritis in several large joints
• Heart inflammation
• Nodules under the skin
• Rapid, jerky movements (chorea, sydenham chorea)
• Skin rash

The minor criteria include:

• Fever
• High ESR
• Joint pain
• Abnormal EKG

You'll likely be diagnosed with rheumatic fever if you:

• Meet 2 major criteria, or 1 major and 2 minor criteria, and.
• You have signs of a past strep infection.

Treatment

If you or your child is diagnosed with acute rheumatic fever you will be treated with antibiotics. The goal of this treatment is to remove all of the strep bacteria from the body.

After the first treatment is complete, more antibiotics are prescribed. The goal of these medicines is to prevent rheumatic fever from recurring.

• All children will continue the antibiotics until age 21.
• Teenagers and young adults will need to take antibiotics for at least 5 years.

If you or your child had heart problems when the rheumatic fever occurred, antibiotics may be needed for even longer, perhaps for life.

To help manage swelling of inflamed tissues during acute rheumatic fever, medicines such as aspirin or corticosteroids may be needed.

For problems with abnormal movements or abnormal behaviors, medicines often used to treat seizures may be prescribed.

Outlook (Prognosis)

Rheumatic fever can cause severe heart problems and heart damage.

Possible Complications

Long-term heart problems can occur, such as:

• Damage to heart valves. This damage may cause leakage in the heart valve or narrowing that slows blood flow through the valve
• Damage to the heart muscle.
• Heart failure.
• Infection of the inner lining of your heart (endocarditis).
• Swelling of the membrane around the heart (pericarditis).
• Heart rhythm that is fast and unsteady.
• Sydenham chorea.

When to Contact a Medical Professional

Call your provider if you or your child develops symptoms of rheumatic fever. Because several other conditions have similar symptoms, you or your child will need careful medical evaluation.

If symptoms of strep throat develop, tell your provider. You or your child will need to be checked and treated if strep throat is present. This will decrease the risk of developing rheumatic fever.

Prevention

The most important way to prevent rheumatic fever is by getting quick treatment for strep throat and scarlet fever.

Alternative Names

Streptococcus - rheumatic fever; Strep throat - rheumatic fever; Streptococcus pyogenes - rheumatic fever; Group A streptococcus - rheumatic fever

Read More