Adult cardiac, endovascular, and thoracic aortic surgery
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Total circulatory arrest (cardiogenic shock) - an inadequate circulation of blood due to primary failure of the ventricles of the heart to function effectively.
Since this is a category of shock there is insufficient perfusion of tissue (i.e. the heart) to meet the required demand for oxygen and nutrients. This leads to cell death from oxygen starvation, hypoxia. Because of this it may lead to cardiac arrest (or circulatory arrest) which is an acute cessation of cardiac pump function.
Causes: 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, systolic anterior motion (SAM) in hypertrophic cardiomyopathy), ventriculoseptal defects or medical error.
Treatment: In cardiogenic shock: depending on the type of myocardal infarction one can infuse fluids or in shock refractory to infusing fluids inotropica. In case of cardiac arrhythmia several anti-arrhythmic agents may be administered, i.e. adenosine, verapamil, amiodarone, -blocker. Positive inotropic agents, which enhance the heart's pumping capabilities, are used to improve the contractility and correct the hypotension. 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).
Signs & symptoms:
- Anxiety, restlessness, altered mental state due to decreased cerebral perfusion and subsequent hypoxia.
- Hypotension 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 insufficient renal perfusion if condition persists.
- Rapid and deep respirations (hyperventilation) due to sympathetic nervous system stimulation and acidosis.
- Fatigue due to hyperventilation and hypoxia.
- Absent pulse in tachyarrhythmia.
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