WordNet

be in control; "Her husband completely dominates her"
look down on; "The villa dominates the town" (同)command, overlook, overtop
have dominance or the power to defeat over; "Her pain completely mastered her"; "The methods can master the problems" (同)master
strike with horror or terror; "The news of the bombing shocked her"
(pathology) bodily collapse or near collapse caused by inadequate oxygen delivery to the cells; characterized by reduced cardiac output and rapid heartbeat and circulatory insufficiency and pallor; "loss of blood is an important cause of shock"
subject to electrical shocks
the violent interaction of individuals or groups entering into combat; "the armies met in the shock of battle" (同)impact
an unpleasant or disappointing surprise; "it came as a shock to learn that he was injured" (同)blow
an instance of agitation of the earths crust; "the first shock of the earthquake came shortly after noon while workers were at lunch" (同)seismic disturbance
a bushy thick mass (especially hair); "he had an unruly shock of black hair"
a pile of sheaves of grain set on end in a field to dry; stalks of Indian corn set up in a field; "corn is bound in small sheaves and several sheaves are set up together in shocks"; "whole fields of wheat in shock"
surprise greatly; knock someones socks off; "I was floored when I heard that I was promoted" (同)floor, ball over, blow out of the water, take aback
strike with disgust or revulsion; "The scandalous behavior of this married woman shocked her friends" (同)offend, scandalize, scandalise, appal, appall, outrage
collect or gather into shocks; "shock grain"
collide violently

PrepTutorEJDIC

…‘を'『支配する』,‘に'君臨する / …‘で'優位を占める,幅を利かす / …‘を'見下ろす位置にある;…‘の'上にそびえ立つ / (…を)支配する,威圧する《+『over』+『名』》 / 《副詞[句]を伴って》優勢である
〈C〉(衝突・爆発などの)『衝撃』,(地震の)震動,電撃 / 〈C〉〈U〉(精神的)『打撃』,ショック / 〈U〉ショック症 / 《しばしば受動態で》〈人〉‘を'『ぎょっとさせる』,ひどく驚かせる / (治療のため)〈人・動物〉‘に'電気ショクを与える
(乾燥させるために立てかけた)穀類の刈り束 / 〈穀類〉‘を'刈り束にする
(髪の毛の)もじゃもじゃの固まり《+『of』+『名』》
びっくりさせる,ぞっとする / 全くひどい(very bad),不愉快な(offensive)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/06 01:22:44」(JST)

wiki en

Cardiogenic shock is a life-threatening medical condition resulting from an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively.^[1]^[2]^[3]^[4]^[5]

As this is a type of circulatory shock, there is insufficient perfusion of tissue to meet the demands for oxygen and nutrients. Cardiogenic shock is a largely irreversible condition and as such is more often fatal than not.^[6] The condition involves increasingly more pervasive cell death from oxygen starvation (hypoxia) and nutrient starvation (e.g. low blood sugar).^[7]^[8] Because of this, it may lead to cardiac arrest (or circulatory arrest), which is an abrupt stopping of cardiac pump function.^[4]

Cardiogenic shock is defined by sustained low blood pressure with tissue hypoperfusion despite adequate left ventricular filling pressure. Signs of tissue hypoperfusion include oliguria (<30 mL/h), cool extremities, and altered level of consciousness.

Treatment of cardiogenic shock depends on the cause. If due to a heart attack attempts to opening the arteries to the heart may help. An intra-aortic balloon pump or left ventricular assist device may improve matter until this can be done. Inotropes may help; however, it is unclear which is best. Norepinephrine may be better if the blood pressure is really low while dopamine or dobutamine may be more useful if only slightly low.^[9]

Signs and symptoms

Anxiety, restlessness, altered mental state due to decreased blood flow to the brain and subsequent hypoxia.
Low blood pressure due to decrease in cardiac output.
A rapid, weak, thready pulse due to decreased circulation combined with tachycardia.
Cool, clammy, and mottled skin (cutis marmorata) due to vasoconstriction and subsequent hypoperfusion of the skin.
Distended jugular veins due to increased jugular venous pressure.
Oliguria (low urine output) due to inadequate blood flow to the kidneys if the condition persists.
Rapid and deeper respirations (hyperventilation) due to sympathetic nervous system stimulation and acidosis.
Fatigue due to hyperventilation and hypoxia.
Absent pulse in fast and abnormal heart rhythms.
Pulmonary edema, involving fluid back-up in the lungs due to insufficient pumping of the heart.

Causes

Cardiogenic shock is caused by the failure of the heart to pump effectively. It can be due to damage to the heart muscle, most often from a large myocardial infarction. Other causes include arrhythmia, cardiomyopathy, cardiac valve problems, ventricular outflow obstruction (i.e. aortic valve stenosis, aortic dissection, cardiac tamponade, constrictive pericaditis systolic anterior motion (SAM) in hypertrophic cardiomyopathy) or ventriculoseptal defects. It can also be caused by a sudden decompressurization (e.g. in an aircraft), where air bubbles are released into the bloodstream (Henry's Law), causing heart failure.^[1]^[2]^[3]^[4]^[5]^[10]^[11]

Diagnosis

Electrocardiogram

An electrocardiogram helps establishing the exact diagnosis and guides treatment, it may reveal:

Cardiac arrhythmias
myocardial infarction
Signs of cardiomyopathy

Ultrasound

Echocardiography may show poor ventricular function, signs of PED, ventricular septal rupture (VSR), an obstructed outflow tract or cardiomyopathy.

Swan-ganz catheter

The Swan-ganz catheter or pulmonary artery catheter may assist in the diagnosis by providing information on the hemodynamics.

Biopsy

In case of suspected cardiomyopathy a biopsy of heart muscle may be needed to make a definite diagnosis. but biopsy should only be done when third space is suspected

Treatment

In cardiogenic shock, depending on the type of myocardial infarction, treatment involves infusion of fluids, or in shock refractory to fluids, inotropic medications. In case of an abnormal heart rhythm several anti-arrhythmic agents may be administered, i.e. adenosine, verapamil (source is outdated - verapamil and β-blocker are contraindicated in cardiogenic shock), amiodarone, β-blocker or glucagon.^[12] Positive inotropic agents, which enhance the heart's pumping capabilities, are used to improve the contractility and correct the low blood pressure. Should that not suffice an intra-aortic balloon pump (which reduces workload for the heart, and improves perfusion of the coronary arteries) can be considered or a left ventricular assist device (which augments the pump-function of the heart).^[1]^[2]^[3] Finally, as a last resort, if the patient can be made stable enough and otherwise qualifies, cardiac transplantation can be performed. These invasive measures are important tools- more than 50% of patients who do not die immediately due to cardiac arrest from a lethal arrthythmia and live to reach the hospital (who have usually suffered a severe acute myocardial infarction, which in itself still has a relatively high mortality rate), die within the first 24 hours. The mortality rate for those still living at time of admission who suffer complications (among others, cardiac arrest or further arrhythmias, heart failure, cardiac tamponade, a ruptured or dissecting aneurysm, or another heart attack) from cardiogenic shock is even worse around 85%, especially without drastic measures such as ventricular assist devices or transplantation.

Cardiogenic shock may be treated with intravenous dobutamine, which acts on β₁ receptors of the heart leading to increased contractility and heart rate. ^[13]

References

^ ^a ^b ^c Rippe, James M.; Irwin, Richard S. (2003). Irwin and Rippe's intensive care medicine. Philadelphia: Lippincott Williams & Wilkins. ISBN 978-0-7817-3548-3. OCLC 53868338. ^{[page needed]}
^ ^a ^b ^c Marino, Paul L. (1998). The ICU book. Baltimore: Williams & Wilkins. ISBN 978-0-683-05565-8. OCLC 300112092. ^{[page needed]}
^ ^a ^b ^c Society of Critical Care Medicine. (2001). Fundamental Critical Care Support. Society of Critical Care Medicine. ISBN 978-0-936145-02-0. OCLC 48632566. ^{[page needed]}
^ ^a ^b ^c Textbooks of Internal Medicine
- Harrison's Principles of Internal Medicine 16th Edition, The McGraw-Hill Companies, ISBN 0-07-140235-7
- Cecil Textbook of Medicine by Lee Goldman, Dennis Ausiello, 22nd Edition (2003), W.B. Saunders Company, ISBN 0-7216-9652-X
- The Oxford Textbook of Medicine Edited by David A. Warrell, Timothy M. Cox and John D. Firth with Edward J. Benz, Fourth Edition (2003), Oxford University Press, ISBN 0-19-262922-0
^ ^a ^b Shock: An Overview PDF by Michael L. Cheatham, MD, Ernest F.J. Block, MD, Howard G. Smith, MD, John T. Promes, MD, Surgical Critical Care Service, Department of Surgical Education, Orlando Regional Medical Center Orlando, Florida
^ Nitasha Sarswat, MD And Steven M. Hollenberg, MD (February 2010). "Cardiogenic Shock". Hospital Practice. 38 (1): 74–83. doi:10.3810/hp.2010.02.281. PMID 20469627.
^ Chelliah YR (December 2000). "Ventricular arrhythmias associated with hypoglycaemia". Anaesthesia and Intensive Care 28 (6): 698–700. PMID 11153301.
^ Navarro-Gutiérrez S, González-Martínez F, Fernández-Pérez MT, García-Moreno MT, Ballester-Vidal MR, Pulido-Morillo FJ (December 2003). "Bradycardia related to hypoglycaemia". European Journal of Emergency Medicine 10 (4): 331–3. doi:10.1097/01.mej.0000103764.80742.76. PMID 14676515.
^ Kanter, J; DeBlieux, P (November 2014). "Pressors and inotropes.". Emergency medicine clinics of North America 32 (4): 823–34. PMID 25441037.
^ Cardiogenic shock Department of Anaesthesia and Intensive Care of The Chinese University of Hong Kong
^ Introduction to management of shock for junior ICU trainees and medical students Department of Anaesthesia and Intensive Care of The Chinese University of Hong Kong
^ Hall-Boyer K, Zaloga GP, Chernow B (July 1984). "Glucagon: hormone or therapeutic agent?". Critical Care Medicine 12 (7): 584–9. doi:10.1097/00003246-198407000-00008. PMID 6375966.
^ Rang and Dale's Pharmacology, H.P. Rang, M.M. Dale, J.M.Ritter, R.J. Flower, Churchhill Livingston, Elsevier, 6th Edition

External links

Cardiogenic Shock by eMedicine

UpToDate Contents

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1. 急性心筋梗塞を合併する心原性ショックの予後および治療 prognosis and treatment of cardiogenic shock complicating acute myocardial infarction
2. 成人における確定診断を得られていない低血圧やショックの評価および初期アプローチ evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock
3. 急性心筋梗塞における心原性ショックの臨床症状および診断 clinical manifestations and diagnosis of cardiogenic shock in acute myocardial infarction
4. 成人におけるショックの定義、症状、病因、および病態生理 definition classification etiology and pathophysiology of shock in adults
5. 麻酔後回復室（PACU）における心血管の障害 cardiovascular problems in the post anesthesia care unit pacu

English Journal

Experts' recommendations for the management of adult patients with cardiogenic shock.

Levy B1, Bastien O, Benjelid K, Cariou A, Chouihed T, Combes A, Mebazaa A, Megarbane B, Plaisance P, Ouattara A, Splaulding C, Teboul JL, Vanhuyse F, Boulain T, Kuteifan K.
Annals of intensive care.Ann Intensive Care.2015 Dec;5(1):52. doi: 10.1186/s13613-015-0052-1. Epub 2015 Jul 1.
Unlike for septic shock, there are no specific international recommendations regarding the management of cardiogenic shock (CS) in critically ill patients. We present herein recommendations for the management of cardiogenic shock in adults, developed with the Grading of Recommendations Assessment, D
PMID 26152849

Long-term survival of elderly patients undergoing percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock.

Lim HS1, Andrianopoulos N2, Sugumar H3, Stub D4, Brennan AL2, Lim CC5, Barlis P6, Van Gaal W6, Reid CM2, Charter K3, Sebastian M7, New G8, Ajani AE9, Farouque O10, Duffy SJ11, Clark DJ12; Melbourne Interventional Group.
International journal of cardiology.Int J Cardiol.2015 Sep 15;195:259-64. doi: 10.1016/j.ijcard.2015.05.130. Epub 2015 May 22.
BACKGROUND: The long-term benefit of early percutaneous coronary intervention (PCI) for cardiogenic shock (CS) in elderly patients remains unclear. We sought to assess the long-term survival of elderly patients (age ≥75years) with myocardial infarction (MI) complicated by CS undergoing PCI.METHODS
PMID 26048389

Transient apical wall thickening in patients with stress cardiomyopathy: Prevalence, profile, and impact on clinical course.

Shin DG1, Cho IJ1, Shim CY1, Ryu SK2, Chang HJ1, Hong GR3, Ha JW1, Chung N1.
International journal of cardiology.Int J Cardiol.2015 Sep 1;194:87-92. doi: 10.1016/j.ijcard.2015.05.101. Epub 2015 May 19.
BACKGROUND: Transient apical wall thickening (TAWT), mimicking apical hypertrophic cardiomyopathy during recovery from stress cardiomyopathy (SCM), has recently been reported. However, the clinical significance of this phenomenon has not yet been assessed. We aimed to explore the prevalence, profile
PMID 26011273

Japanese Journal

Effect of Abciximab Therapy in Patients Undergoing Coronary Angioplasty for Acute ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock

De Felice Francesco,Tomassini Francesco,Fiorilli Rosario [他]
Circulation journal : official journal of the Japanese Circulation Society 79(7), 1568-1574, 2015-07
NAID 40020502432