Cardiogenic Shock Treatment

The main goal for treatment of cardiogenic shock is reestablishing myocardial circulation, minimize heart muscle damage, and improve the pumping function of the heart. First-line treatment can utilize antishock trousers which compress the legs and shunt blood flow to the vital organs. Metallic PET film blankets can be used to reflect the patient’s body heat to keep the patient warm (Wikipedia, 2008).

If a structural disorder is causing cardiogenic shock, they are repaired surgically. These may include septal rupture or dysfunction of the valves. Thrombosis of the coronary arteries is treated usually with angioplasty or stenting, coronary artery bypass grafting, or thrombolysis. Arrhythmias are treated medically or with cardioversion if indicated (Weil, 2007). Shock resulting from an acute myocardial infarction is usually treated with fluids if the CVP is low. If a pulmonary artery catheter is not in place, often small boluses of fluid (250 mL to 500 mL) are given to see if the patient’s vital signs improve. This is done with care, while frequently auscultating the lungs and looking for signs and symptoms of fluid overload. Vasopressors may also be instituted to maintain adequate blood pressure (Weil, 2007).

For moderate hypotension, dopamine may be used for its inotropic effects to improve cardiac output and reduce left ventricular filling pressure, monitoring for possible arrhythmias that can result from the administration of this drug. Vasodilators may also be used to increase venous capacitance and lower systemic vascular resistance to reduce afterload on the damaged heart muscle (Weil, 2007).   For more serious hypotension, norepinephrine or dopamine may be utilized. Intraaortic balloon pumps may be helpful to temporarily reverse the effects of shock in patients with an acute myocardial infarction. This procedure is considered temporary as a bridge to cardiac catheterization and coronary angiography before surgical intervention can take place in patients with a myocardial infarction complicated by septal rupture or valvular dysfunction who require vasopressors for greater than 30 minutes (Weil, 2007). 

A left ventricular assist device may also be instituted to augment the pumping action of the heart (Wikipedia, 2008). In obstructive shock, therapy consists of removing the obstruction (Wikipedia, 2008). Pericardiocentesis can relieve the pressure on the heart from cardiac tamponade. Decompression of a tension pneumothorax should be immediately undertaken via catheter insertion or chest tube placement into the thorax. Pulmonary embolism is treated via thrombolysis or surgical embolectomy (Weil, 2007).