298 Cardio Shock Flashcards
Cardiogenic shock and pulmonary edema
Most common joint etiology of Cardiogenic shock and pulmonary edema
Severe LV dysfunction from myocardial infarction
Clinical features of peripheral hypoperfusion in cardiogenic shock
Elevated arterial lactate of more than 2 mmol/L
Uncommon cause of transient Cardiogenic shock
Takotsubo syndrome
Type of Myocardial infarct associated with cardiogenic shock
Anterior wall myocardial infarction
Associated with increased risk for cardiogenic shock
Patients with MI Patient with prior MI Older age Diabetes Mellitus Anterior MI location Multivessel CAD with extensive coronary artery stenoses
MADAM PO
Target BP or MAP in patients with cardiogenic shock
MAP of 60-65 mmHg
Systolic BP of 90 mmHg
Target blood glucose level in acute myocardial infarction
CBG less than 180 mg/dL
Only evidence based treatment strategy for mortality reduction in cardiogenic shock
Rapid revascularization of infarct related artery
Preferred reperfusion strategy
PCI with drug-eluting stent of the infarct related artery
Reasonable first line vasopressor. Started at what dose
Norepinephrine 2 to 4 mcg/min titrated upward based on blood pressure
Why is Dopamine avoid as first line therapy for MI with cardiogenic shock
Dopamine has proarhythmogenic effect
Synthetic sympathomimetic amine with positive inotropic action and minimal positive chronotropic activity. Preferred dose and why?
Dobutamine at 2.5 mkm. Higher doses have moderate chronotropic activity
Most commonly used mechanical circulatory support device. When is it contraindicated?
Intra aortic balloon pump (IABP)
No longer recommended for CS with LV failure
Six variables in the IABP Shock II score
Age more than 75
Prior stroke
Glucoze more than 191 mg/dl or 10.6 mmol on admission
Creatinine of more than 132.6 mmol/L
TIMI score after PCI less than 3
Arterial blood lactate more than 5 mmol/L
GAP CAT
Predominant RV failure accounts for how many percent of cardiogenic shock
5%
Most common cause of RV failure
Proximal RCA occlusion
What is the target in fluid resuscitation in RV CS?
Fluid administration to optimize right atrial pressure 10-15 mmHg
Complication of Acute MI that often occurs on the first day with a second peak several days later
Acute severe MR due to papillary muscle dysfunction
Rare complication of Acute myocardial infarction that occurs 24H after but may occur up to 2 weeks later
Ventricular septal rupture occurs 1-2% in patient with cardiogenic shock withOUT reperfusion and reduced to 0.2% in era of reperfusion
Definitive treatment of Acute severe mitral regurgitation resulting from acute myocardial infarction
Mitral valve repair or reconstruction
Dramatic complication of Acute myocardial infarction occurring during first week. Presents with sudden loss of pulse, BP and consciousness but sinus rhythm on ECG (Pulseless electrical activity) due to cardiac tamponade
Myocardial free wall rupture
Target oxygenation saturation in pulmonary edema
O2 sat of 92%
Venodilatoe that rapidly reduced preload before any diuresis occurs. Diuretic of choice. What’s the initial dose and higher dose?
Furosemide. Initial dose of 0.5 mg/kg. Higher dose of 1 mg/kg
First line therapy for acute cardiogenic pulmonary edema
Sublingual nitroglycerin 0.4 mg x 3 every 5 mins
If still persists, IV nitroglycerin 5 - 10 mcg/min
Potent venous and arterial vasodilator but not recommended in states of reduced coronary artery perfusion
Nitroprusside 0.1-5 mcg/kg/min
Transient venodilator that reduced preload while relieving dyspnea and anxiety
Morphine
Reduces both preload and afterload with known mortality benefit
ACE inhibitors
IV recombinant brain natriuretic peptide reserved for refractory pulmonary edema not due to myocardial ischemia
Nesiritide
Bipyridine phosphodiesterase-3 inhibitors (inodilators) which stimulate myocardial contractility while promoting peripheral and pulmonary vasodilation
Milrinone 50 mcg/kg followed by 0.25- 0.75 mcg/kg/min
How to prevent high altitude pulmonary edema
Dexamethasone
CCB
LABA
