A dangerous condition in which the heart is unable to pump blood: Everything about Cardiogenic Shock

Have you suddenly found yourself short of breath, cold, and dizzy? You might think it's just fatigue. But, it can also be a sign of a very dangerous condition. It's a situation where the heart can't pump enough blood to the body. In medicine, we call this Cardiogenic Shock. This is a condition that requires emergency medical treatment and can even be life-threatening. So let's talk about it in simple terms today.

Simply put, what is Cardiogenic Shock?

Imagine what would happen if the motor that pumps water into your home's water tank suddenly stopped working? There would be no water in the tank, no water for bathing or drinking. The heart in our body is like this water motor. The main function of the heart is to pump blood full of oxygen and nutrients to every cell and organ in the body.

Cardiogenic Shock is when the heart, the 'pump', stops working properly and cannot pump enough blood to the body. When this happens, our major organs, such as the brain, kidneys, and liver, do not get the oxygen they need. Just like trees die without water, without oxygen, these organs begin to suffer. This is a medical emergency . If left untreated, death can occur.

Are there different stages of this condition?

Yes, this condition does not reach its peak all at once. There are times when it gradually gets worse. Doctors divide it into several stages according to its severity. When we understand this, we can get a good idea of ​​the severity of the condition.

How to recognize? Symptoms of Cardiogenic Shock

If you have one or more of these symptoms, don't ignore them. You should be very careful about this, especially if you have heart disease.

• Confusion or loss of consciousness: When blood flow to the brain is reduced, consciousness may become impaired, agitated, or drowsy.
• Fainting: You may suddenly lose consciousness and fall.
• Difficulty breathing: Fluid may accumulate in the lungs and make it feel like you are having trouble breathing.
• Decreased urine output: When blood flow to the kidneys decreases, the amount of urine produced by the body decreases significantly.
• Cold hands and feet: As the body tries to send blood to the body's vital organs, blood flow to remote areas like the hands and feet decreases. As a result, they become cold and sweat.
• Skin color changes: The skin becomes pale, possibly turning blue.
• Extreme fatigue and exhaustion: The body becomes so exhausted that it is impossible to do anything.
• Swelling of the abdomen and legs: Fluid accumulates in the body and causes swelling because the heart is not working properly.
• Anorexia: Losing all desire to eat.

What is the main reason for this?

The main and most common cause of cardiogenic shock is a severe heart attack . When a heart attack occurs, a blood vessel that supplies blood to the heart muscle becomes blocked. This damages the muscle and suddenly reduces the heart's ability to pump.

But it's not just heart disease, there are many other reasons that can affect this. Simply put, anything that interferes with the functioning of the heart can cause this.

• Myocarditis: When the heart muscle becomes inflamed due to something like a viral infection, the heart is unable to contract properly.
• Heart valve infection (Endocarditis): When the heart valves become infected with bacteria, they become damaged and blood flow becomes impaired.
• Heartbeat abnormalities (Arrhythmia): If the heart beats too fast or too slow, it cannot pump blood properly.
• Cardiac Tamponade: When the sac-like area around the heart fills with fluid or blood , the pressure prevents the heart from contracting and pumping blood.
• Pulmonary Embolism: When a blood clot, like a leg clot, breaks loose and becomes lodged in a major blood vessel in the lungs, it puts a lot of pressure on the heart.
• Heart valve problems: Sudden rupture of a heart valve, or a prosthetic valve not working properly.
• A severe blow to the chest: A blow to the chest from an accident can damage the heart.

How do doctors find this?

When you go to the hospital, the doctor will first get an idea of ​​this from the questions he asks you and the physical examination.

Things seen during physical examination:

• Feeling weak pulses when palpating.
• Skin that feels cold and clammy to the touch.
• Having very low blood pressure .
• Hearing an abnormal heart sound (murmur) when listening to the chest with a stethoscope.

Then, several tests are performed to confirm the diagnosis and find the cause.

What tests are performed?

• ECG (Electrocardiogram): This measures the electrical activity of the heart. It can quickly detect whether there is a heart attack or an abnormality in the heartbeat.
• Echocardiogram (Echo): This is like a scan of the heart. It can clearly see how well the heart is pumping blood, whether there are any problems with the valves, and whether there is any damage to the heart muscle.
• Chest X-ray: A chest X-ray is used to check for fluid in the lungs and an enlarged heart.
• Blood Tests: Blood oxygen levels, kidney and liver function, and cardiac enzyme levels are checked to see if there is any damage to the heart.
• Cardiac Catheterization: This is a slightly more complicated test. A thin tube is inserted through a blood vessel in your arm or leg and guided into your heart to check for blockages in the coronary arteries. It also measures the pressure inside your heart to determine how well it is pumping.

How is it treated?

Since this is an emergency, treatment begins in the hospital's Emergency Treatment Unit (ETU) or Intensive Care Unit (ICU). There are two main goals:

1. Supporting heart function.

2. Minimize damage to body organs.

Emergency treatment

• Providing oxygen: Provide the body with the oxygen it needs, and may need to be connected to a ventilator.
• Types of medicines:
• Medicines that increase blood pressure (Vasopressors).
• Medicines that increase the pumping ability of the heart (Inotropes).
• Diuretics are medications that remove excess fluid from the body.
• Heart support devices: If the condition cannot be controlled with medication alone, a device is used to temporarily support the heart. An example is a device called an Intra-aortic balloon pump (IABP).

Treatment according to the cause

Once the patient's condition has been stabilized to some extent through emergency treatment, the underlying problem that caused the cardiogenic shock is treated.

• If it's due to a heart attack: Angioplasty is performed immediately. This means that the blocked blood vessel is opened with a balloon and a stent is inserted to prevent it from getting blocked again.
• If there is a valve problem: Surgery is performed to repair the valve or insert a new valve.
• If a blood clot is lodged in the lungs: Medication to dissolve the clot will be given.
• If there is fluid around the heart: The fluid is removed with a needle.

In some severe cases, if the heart is unable to function at all, a machine called ECMO (extracorporeal membrane oxygenation) is used. This is done by adding oxygen to the blood outside the body and returning it to the body. This means that the work of the heart and lungs is temporarily done by this machine. If the heart does not recover, it may be necessary to install a long-term device called an LVAD (left ventricular assist device) or even go as far as a heart transplant .

Recovery and the way forward

Cardiogenic shock is a very serious condition. The chances of survival depend on how quickly treatment is received. The shorter the time spent in shock, the less damage to the organs.

• Hospital stay: Usually, you will have to stay in the hospital for a week or more.
• Recovery time: It can take several weeks to several months to fully recover after returning home. Participating in cardiac rehabilitation programs can greatly help the recovery process.
• Future life: After an experience like this, there may be some physical and mental effects. Therefore, it is essential to take the medication prescribed by the doctor on time, attend the clinics on the scheduled dates, and make the necessary lifestyle changes (quitting smoking, eating healthy, exercising).