Cardiogenic Shock: Causes, Symptoms & Treatment Video

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  • 0:01 In a State of Shock
  • 0:32 Cardiogenic Shock
  • 2:26 A Point of Clarification
  • 3:52 Pathophysiology
  • 7:50 Treatment Options
  • 8:24 Lesson Summary
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Lesson Transcript
Instructor: Artem Cheprasov
In this lesson, we will take a look at something known as shock, define it, and look at a particular form of it known as cardiogenic shock. We'll discuss what may trigger it, what it does to the body, how the body tries to compensate for it, and how it may be treated.

In a State of Shock

When you are in a state of shock, your eyes are wide open and your jaw drops. Whatever it is that causes you that shock, you're often not thinking straight and are sometimes completely immobilized from all that anxiety and surprise. Of course, the term 'shock' is many times used loosely and doesn't really reference the reality of medical shock. Thus, I'm going to cover a more serious case of shock, one that has nothing to do with being caused by the latest ratings ploy by your favorite attention-seeking entertainer.

Cardiogenic Shock

Other than a paper bag over a person's head on a red carpet, inappropriate bodily gyrations, and a 'wardrobe malfunction,' shock can occur as a result of something known as cardiogenic shock. Cardiogenic shock is a state of inadequate cardiac output despite adequate intravascular volume, resulting in hypoxia. Cardiac output refers to the volume of blood your heart pumps out into circulation, intravascular volume is the amount of fluid within your blood vessels, and hypoxia refers to an inadequate amount of oxygen supply or utilization in a region of, or the entire, body.

In general, shock, medically speaking, refers to a physiological state of inadequate tissue perfusion throughout the body, resulting in cellular malfunction and tissue death, most importantly in the heart, kidneys, and brain. In 'normal person speak,' this means that your tissues and organs do not receive normal amounts of oxygen via the blood vessels. Since your cells, organs, and tissues rely on oxygen to function, the lack of oxygen delivery leads to cellular death, subsequent organ malfunction, and death thereafter.

One of the causes for this is heart disease, as I just mentioned. That's why we term shock stemming from heart problems as 'cardiogenic.' Think of the heart as the pump fueling the sprinkler system in our backyard. The sprinkler system consists of pipes and sprinklers watering the grass. If the pump fails, then the pipes get little water, and the sprinklers can't spray the grass with life-giving water. This means the grass will eventually wilt and die.

A Point of Clarification

Anyhow, it is often erroneously assumed that shock always refers to a state where low blood pressure (hypotension) is measured in a patient. This is not true. In early stages of shock, a person's blood pressure may be completely normal or even increased. In fact, if a patient is hypotensive, that means they are in the worst stages of shock, when the body can no longer compensate for this dire situation using internal emergency mechanisms.

Furthermore, in a basic sense, tissue perfusion refers to the volume of blood flowing through a particular tissue. It is not synonymous with blood pressure, nor do they always go hand in hand. The thing is, sometimes a person's blood pressure is just fine, but they have inadequate tissue perfusion.

For instance, if a blood vessel flowing to a tissue is blocked by something like a clot, blood pressure and blood volume may be perfectly fine in 99% of the body, but at the point following the blockage, tissue perfusion will be nonexistent. Basically, if one pipe in your sprinkler system is blocked, then the patch of grass supplied by that pipe will die, even though the water pressure in the pipe itself is just fine.

Pathophysiology of Cardiogenic Shock

The most common cause of cardiogenic shock is a severe heart attack, many times as a result of coronary heart disease that leads to myocardial ischemia, an inadequate supply of oxygen to the heart as a result of clogged coronary arteries. The bottom line is that in cardiogenic shock, the heart is unable to properly contract as a result of serious damage. If your heart can't contract appropriately, then it cannot pump enough blood into the aorta and out into circulation, resulting in tissue hypoperfusion (or low tissue perfusion).

Tissues that do not receive an adequate blood flow through them accumulate lactic acid (or lactate) as a result of energetic processes that occur in low-oxygen states. This is the same stuff that accumulates in your muscles after you work out a lot. Accumulation of this causes acidosis, a state of too much acid in the body, which is not conducive to life. Therefore, a person in shock may be hyperventilating, or breathing very quickly, in order to breathe acidic CO2 out of the body. Getting rid of excess acidic substances by breathing them out obviously helps to minimize the effects of acidosis caused by low oxygen states.

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