Cardiac disorders: Cardiogenic Shock

Question 1

Define cardiogenic shock.

Answer 1

Inadequate cellular metabolism secondary to cardiac dysfunction when there is adequate intravascular volume

Question 2

True or False: Patients that demonstrate an acute decrease in cardiac output abruptly develop cardiogenic shock and also evidence of left sided heart failure.

Answer 2

False, while abruptly developing cardiogenic shock, patients may develop evidence of right sided heart failure

Question 3

Clinical signs of cardiogenic shock include -?

Answer 3

Depression, unresponsiveness, or disorientation; Cold peripheral extremities, pale MM, prolonged CRT; Increased heart rate; Lactic acidosis with a compensatory respiratory alkalosis

Question 4

A diagnosis of cardiogenic shock may be made if there is evidence of _________ _________ in the presence of adequate end-diastolic volume.

Answer 4

Systolic dysfunction

Question 5

Systolic dysfunction can result from -?

Answer 5

Decreased cardiac contractility, or decreased flow through the left ventricular outflow tract

Question 6

What cardiac disorders are associated with a failure of contraction and a decreased end-diastolic volume (systolic dysfunction)?

Answer 6

Dilated cardiomyopathy, sepsis, endomyocarditis, or myocardial infarction

Question 7

(Diastolic/systolic) failure occurs due to inadequate ventricular filling. This can result from -?

Answer 7

Diastolic

Hypovolemia, pericardial effusion, inability of the myocardium to relax (hypertrophic cardiomyopathy), or inadequate time for filling (tachycardia)

Question 8

Treatment for patients with systolic dysfunction include -?

Answer 8

Diuretics if there is evidence of left sided heart failure, and positive inotropes (beta-1 agonists, phosphodiesterase inhibitors, cardiac glycosides)

Question 9

Treatment for patients with diastolic failure/ dysfunction (hypovolemia, pericardial effusion, hypertrophic cardiomyopathy, tachyarrhytmias) includes -?

Answer 9

Hypovolemia = appropriate fluid therapy

Pericardial effusion = reflex tachycardia, pericardiocentesis, fluid therapy

Hypertrophic cardiomyopathy = (often associated with backward blood flow) beta blockers, calcium channel antagonists

Tachyarrhythmia = vagal maneuvers, calcium channel antagonists, beta blockers

Question 10

Artificial pacemakers should be considered in patients with what bradyarrhythmias? Why?

Answer 10

severe, high grade 2nd degree or 3rd degree AV block

As a result of abnormal conduction, other complexes are stimulated causing inappropriate contractions, and as a result of exertion, output may be inadequate and lead to cardiogenic shock