心原性的 冲击

迹象 & 症状

心源性休克患者可能会经历:

• 快速的呼吸
• 呼吸严重短促
• 突然、快速的心跳(心动过速)
• 失去知觉
• 微弱的脉搏
• 低血压(低血压)
• 出汗
• 苍白的皮肤
• 手脚冰凉
• 排尿少于正常或根本不排尿

Because cardiogenic shock usually results from a severe heart attack, 人们也可能会出现心脏病发作的症状. 这些包括:

• 压力, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
• Pain extending to your shoulder, one or both arms, back, or even to your teeth and jaw
• 胸痛发作次数增加
• 呼吸急促（气促）
• 出汗
• 头晕或突然头晕
• 恶心和呕吐

诊断

Often the diagnosis of cardiogenic shock is made by the emergency medical team in the ambulance or at the hospital. These are some of the tests they may use to determine whether you had a heart attack and whether you have cardiogenic shock:

• Blood pressure measurements – 心原性的 shock usually causes low blood pressure.
• 胸部x光片 – The images provide information about your heart and blood vessels, 还能显示你的肺部是否有液体.
• 心电图(心电图) -这项测试测量你的心脏电活动.
• 超声心动图 – This ultrasound of the heart can show blockages in the arteries and how the blood is flowing.
• Blood tests – Various analyses can reveal whether the blood has too much carbon dioxide or too little oxygen (both signs of cardiogenic shock) and can check levels of tropinin, proteins that are released when heart muscle is damaged (as occurs during a heart attack).
• 心脏导管插入术 – This technique can be used to look for blocked areas in your arteries and to check the amount and pressure of blood that your heart is pumping with each beat.

治疗

The goal of cardiogenic shock treatment is to quickly restore blood pressure and heart function. This often requires a series of immediate treatments that are given in an ambulance or the emergency room. Other treatments may include medications or temporary support devices to restore blood flow as well as longer-term therapies to address the underlying condition that caused the heart to stop pumping enough blood.

紧急和短期治疗

Emergency treatments may include delivering enriched oxygen via a tube or mask; breathing assistance, using a ventilator; and intravenous (IV) fluids and medications to support blood pressure or heart function.

Depending on the cause of cardiogenic shock, an array of drugs may be used as part of treatment. 这些包括:

• Clot-busting drugs, such as tissue plasminogen activator (tPA) to dissolve coronary artery clots
• Anticlotting medicines – such as aspirin, clopidogrel or heparin – to prevent new clots
• Drugs to increase the heart's pumping ability, such as dobutamine, dopamine and norepinephrine
• 硝酸甘油可以放松和扩张血管
• Drugs that decrease the heart's workload and pain, relieve anxiety or regulate heart rhythm

如果药物不能稳定你的病情, your doctor may advise use of a support device that can temporarily take over the job of pumping your blood, restoring proper blood flow and giving your heart time to recover. 这些设备不需要侵入性手术. 选项包括:

• Intra-aortic balloon pump – A tiny balloon is placed in the aortic artery (the heart's main artery) via a thin, flexible tube called a catheter; the balloon inflates and deflates to move blood coming from your heart.
• Impella heart pump – Delivered via a catheter threaded through an artery, 这个小泵被植入心脏的左侧. It draws oxygenated blood from the heart and pushes it out to the body.
• 体外膜肺氧合 – An external device is used to pump and oxygenate your blood, allowing your heart and lungs to rest.

长期治疗

Once doctors have determined the cause of a patient's cardiogenic shock, they may recommend various procedures or devices to address the underlying problem.

对于冠状动脉阻塞，治疗方法包括:

• Coronary bypass surgery – a procedure to create a new route that allows blood to flow around a narrowed or blocked artery
• 经皮冠状动脉介入治疗 – minimally invasive procedures that use catheters to open a blocked artery and restore blood flow

对于心律异常，治疗方法包括:

• 复律法 – Medication or a brief electric shock resets the heart and restores a normal heartbeat.
• 起搏器 – This small electrical device regulates heartbeats; it's implanted under the skin and connected by wires to your heart.
• 导管消融 – This minimally invasive procedure disrupts the electrical pathways causing the heart to beat too fast or irregularly.

If the cause of cardiogenic shock is a heart defect or advanced 心脏衰竭, 可能需要更广泛的治疗. Possibilities include surgery to repair or replace a faulty valve, 机械循环支架 (辅助心脏泵送的装置)或 心脏移植.