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The Heart in Shock

• Considerable evidence indicates that impairment of cardiac function is an important feature of the "shock syndrome" and that it contributes significantly to the development of terminal cardiovascular collapse and death (1^4). However, some studies of experimental shock are not entirely in accord with this conclusion (5). In any case, it is clear that shock is a multisystem disease involving alterations in many physiological and biochemical processes, including those of the heart, and numerous vicious cycles, any one or a combination of which can lead to eventual irreversibility to treatment. An overall summary of some of the most prominent vicious cycles in the shock syndrome is illustrated in Figure 1. The main cycle can be entered at any one of several points, e.g., blood loss, heart failure, burns, or other forms of trauma. Whatever the initiating factor, the subsequent course is similar in many respects with compensatory mecha-