Cardiogenic shock

Cardiogenic shock is a medical emergency resulting from inadequate blood flow to the body's organs due to the dysfunction of the heart. Signs of inadequate blood flow include low urine production (<30 mL/hour), cool arms and legs, and decreased level of consciousness. People may also have severely low blood pressure. Causes of cardiogenic shock include cardiomyopathic, arrhythmic, and mechanical. Cardiogenic shock is most commonly precipitated by a heart attack. Cardiogenic shock is estimated to complicate 5-10% of all heart attacks. Treatment of cardiogenic shock depends on the cause, with the initial goals to improve blood flow to the body. If cardiogenic shock is due to a heart attack, attempts to open the heart's arteries may help. Certain medications, such as dobutamine and milrinone, improve the heart's ability to contract and can also be used. When these measures fail, more advanced options such as mechanical support devices (such as an intra-aortic balloon pump or left ventricular assist device). Cardiogenic shock is a condition that is difficult to reverse fully, even with an early diagnosis. However, early initiation of treatment may improve outcomes. Care should also be directed to any other organs that are affected by this lack of blood flow (e.g., dialysis for the kidneys, mechanical ventilation for lung dysfunction). Mortality rates for cardiogenic shock are high but have been decreasing in the United States. This is likely due to its rapid identification and treatment in recent decades. Some studies have suggested that this is possibly related to new treatment advances. The 30-day mortality rate for cardiogenic shock after a heart attack is 40%, with a 1-year mortality rate of 50%. Nonetheless, the mortality rates remain high, and multi-organ failure, in addition to cardiogenic shock, is associated with higher rates of mortality.