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Older Adults Part 3 > 7.2 Cardiogenic Shock and Cardiac Assistive Devices > Flashcards

7.2 Cardiogenic Shock and Cardiac Assistive Devices Flashcards

1
Q

Extracorporeal Membrane Oxygenation (ECMO)
Cardiopulmonary Bypass (CPB)

A
  • Highly invasive high risk technology
  • Alternate therapy to CPR
  • Involves circulatory support and oxygenation of patients blood
  • Gas exchange takes place in artificial lungs
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2
Q

Cardiopulmonary Bypass

A
  • Used for operations but can also help in patients who cannot wean from ventilators or require cardiopulmonary support
  • Blood is taken from veins, pumped through a membrane oxygenator (where gas is exchanged) then returned to arterial femoral circulation.
  • Heating mechanism in the pump is used to maintain body temperature
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3
Q

Advantages/Disadvantages to the Above

A

ADVANTAGES
- Rapid deployment without need of surgical intervention
- Provides hemodynamic stability
- Allows more time for further assessment and intervention during episodes of acute hemodynamic decompensation

DISADVANTAGES
- Needs continuous anticoagulation
- Unable to provide extended circulatory support

Contraindications
- Occlusive peripheral vascular disease

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4
Q

Cardiogenic Shock

A
  • Decreased CO leads to inadequate tissue perfusion

Manifestations
- Symptoms of HF
- Shock
- Hypoxia

Management
- Correct Underlying Problem
- REDUCE PRELOAD/AFTERLOAD TO DECREASE CARDIAC WORKLOAD
- Improve oxygenation (restore tissue perfusion)
- Monitor hemodynamic parameters, fluid status, and adjust medication according to assessment data

Medications
- Diuretics
- Positive Inotropes
- Vasopressors

Circulatory Assist Devices
- Intra-Aortic Balloon Pump (IABP)

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5
Q

Intra-Aortic Balloon Pump Counterpulsation

A

IABP Counterpulsation
- Increases coronary artery perfusion and blood flow during diastole by inflation of a balloon in thoracic aorta. The balloon deflates before systolic ejection to decrease afterload.
- Inflation and deflation counter pulse each heartbeat

Results
- Increases coronary artery perfusion and decreases afterload. This increases cardiac output

Goals
- Increase oxygen supply to myocardium
- Decrease Left Ventricular (LV) Work
- Improves CO

Cardiogenic Shock Implications
- Reduces afterload by augmenting perfusion pressure and decreasing workload of left ventricle.

  • Good for patients who suffer acute MI with left ventricular heart failure

IABP
- Improves aortic root pressure during diastole
- Increases coronary artery perfusion
- Decreases myocardial oxygen demand
- Increases oxygen supply
- Decreases excessive preload
- Improves contractility

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6
Q

Physiologic Effects of IABP

A
  • Faster heart rates causes shorter diastole with little change to systole
  • Rapid heart rates increase oxygen demand with little time for oxygen delivery
  • If stroke volume cannot be increased the body naturally increases HR to maintain cardiac output which is costly on oxygen demand
  • IABP helps to increase stroke volume and decrease afterload
  • This causes tachycardia to diminish
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7
Q

Inflation and Deflation of Balloon

A

Inflation
- Increases aortic diastolic pressure
- Increases aortic root pressure
- Increases coronary perfusion pressure
- Increases Oxygen supply

Deflation
- Decreases aortic end-diastolic pressure
- Decreases impedance (resistance) to ejection
- Decreases afterload
- Decreases oxygen demand

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8
Q

Ventricular Assist Device

A
  • Used for intractable HF

Indications
- Severe/Acute Left Ventricular Function post MI or surgery
- End stage HF
- Bridge until transplant

Complications
- Bleeding
- Thromboembolic Events
- RVF (Right Ventricular Failure)
- Infection
- Dysrhythmias
- Nutritional Deficits

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9
Q

Impella

A
  • Mini ventricular assist device (VAD)
  • Pulls blood from left ventricle into ascending aorta at 2.5 L/min
  • Inserted through femoral artery into the left ventricle
  • Camera can be placed for heart evaluation (not in real time)

MANAGEMENT
- Monitor cardiovascular system
- VS
- HR and Rhythm
- Monitor Pulmonary and Renal Systems
- Monitor equiptment
- Monitor labs

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10
Q

Inodilators

A
  • Dobutamine and Milrinone
  • Both positive inotrope and vasodilator

Action
- Increases contractility and decreases afterload (increases CO)
- Increases forward flow, decreases left ventricular end-diastolic pressure

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11
Q

Dopamine

A
  • Increases renal perfusion
  • Improves diuresis
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12
Q

Nitroprusside/Hydralazine

A
  • Reduces afterload
  • Controls blood pressure
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13
Q

Nesiritide

A
  • Reduces afterload
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14
Q

Inotropes

A
  • Dopamine, Dobutamine, Epinephrine, Vasopressin, Isoproterenol, Norepinephrine
  • Increases force of myocardial contraction and CO
  • Used for myocardial contractility issues and cardiogenic shock

Dobutamine
- Used for left ventricular dysfunction (increases contractility and renal perfusion)

Dopamine
- Low dose with loop diuretics help preserve renal function and diuresis (improves renal blood flow)
- When patient is not hypotensive, also use vasodilators for acutely decompensated heart failure.

Inodilators
- Stimulates Beta-Adrenergic receptors in heart/blood vessels to increase contractility and vasodilate.
- Most common are dobutamine and milrinone.
- THEY ARE ALSO CHRONOTROPES SO TITRATE SLOWLY IN PATIENTS WITH TACHYCARDIA OR VENTRICULAR DYSRHYTHMIAS

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15
Q

Phosphodiesterase II Inhibitors

A
  • Milrinone
  • Decreases preload and afterload
  • Causes hypotension and increases risk of dysrhythmias
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16
Q

Vasodilators

A
  • Nitrates, Sodium Nitroprusside, Nesiritide, Clevidipine
  • Decrease preload and afterload

Nitroprusside - MOST RAPID ONSET WITH SHORTEST HALFLIFE
- Given continuous drip
- Requires blood pressure monitoring

IV or ORAL Hydralazine
- Vasodilator (decreased afterload)
- NO NEGATIVE INOTROPE EFFECTS

17
Q

ACE Inhibitors

A
  • Increases cardiac output and decreases sodium retention, blood pressure, CVP (central venous pressure), SVR, pulmonary vascular resistance, pulmonary capillary wedge pressure
18
Q

Intropes

A
  • Affect contraction of the heart

Positive
- Increases contractility
- Ventricles empty more completely thus increases cardiac output
- Dopamine, Digoxin, Epinephrine
- Sympathetic Drugs

Negative
- Decrease Contractility Force
- Parasympathetic Drug
- Betablockers, Quinidine, Lidocaine

19
Q

Chronotropic

A
  • Affects HR

Positive
- Increases HR by accelerating rate of impulses in the SA node
- Sympathetic Drug
- Epinephrine, Atropine, Dopamine

Negative
- Slow down heart rate by decreasing impulses in the SA node
- Acetylcholine, Digoxin, Beta Blockers

20
Q

Dromotrope

A
  • Affect conduction velocity from SA to AV node

Positive
- Increases velocity of conduction
- Sympathetic Drug
- Phenytoin

Negative
- Decreases velocity of Conduction
- Parasympathetic Drug
- Digoxin, Beta Blockers, Acetylcholine, Verapamil

21
Q

Medications

A

Inodilators (Dobutamine, Milrinone)
- Increases contractility
- Decreases afterload (vasodilator) which increases CO
- Increases forward flow and decreases left ventricular end-diastolic pressure

Dopamine - Increase renal perfusion and improves diuresis

Nitroprusside - Reduces afterload and blood pressure control

Nesiritide - Reduces afterload

Hydralazine - Reduces afterload and blood pressure control

22
Q

Inodilators

A
  • Most common is Dobutamine and Milrinone
  • Both increase beta adrenergic receptor stimulation
  • They are also chronotropic (increase HR) so titrate carefully in patients with tachycardia or ventricular dysrhythmias
23
Q

Dobutamine

A
  • Used for patients with left ventricular dysfunction and increases contractility and renal perfusion

Older Adults Part 3 (54 decks)

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