Cardiogenic Shock Flashcards
What is Cardiogenic shock
Inadequate tissue perfusion due to impairment of ventricular contraction (inadequate squeeze of ventricles)
Most often caused by…
Inadequate systole (contraction)
Usually adequate volume with inadequate ventricular contraction
Why is Cardiogenic shock the leading cause of death post-MI?
MI damages a part of the heart which will affect the squeeze on hearts contraction. LAD coronary artery is a large coronary artery perfusing a large area of the heart
Mortality rate
50%- rapid and aggressive treatment is needed
Causes
MI and acute MI
Systolic and diastolic dysfunction
Severe valvular dysfunction
Severe heart failure
Cardiomyopathy
Acute coronary syndrome
Coronary artery disease
Risk factors
Diabetes and HTN
Why diabetes
Diabetics have an increase rate of plaque in the coronaries
Why severe valvular dysfunction?
Could contribute to Cardiogenic shock because valvular stenosis or regurgitation would alter the amount of blood that flows in to the ventricles thus decreasing cardiac output and causing the other heart chambers to work harder
Why severe heart failure
Pt has a weak heart to begin with
Why cardiomyopathy
Large boggy heart won’t be able to contract appropriately
Why ACS
Sudden blockage of blood to the heart
Why CAD
Plaque in the coronary arteries will decrease the blood flow and O2 to the heart which weakens the heart
Clinical symptoms
Chest pain, diaphoresis, nausea, vomiting, tachycardia, hypotension without hypovolemia, distant heart sounds (S3/S4), threads irregular pulses, decreased LOC, JVD, crackles in lungs
Clinical Signs
Peripheral edema
Decreased urine output
Cool extremities
Mottling
Ashen, pale or cyanotic skin
Anxiety
Feeling of impending doom
What causes low urine output
Decreased cardiac output
What causes edema
Fluid backs up into the venous system due to the left and right sides of the heart not contracting correctly.
What causes JVD
A back up of fluid into the right atrium and venous circulation due to inadequate contraction of the right ventricle
Cardiogenic shock occurs when…
There are preexisting heart issues present
Treatment
Oxygen delivery
Revascularizatio
Medication
Oxygen delivery
100% non rebreather mask
Mechanical ventilation
I tea-aortic balloon pump (IABP)
Ventricular assist device (VAD)
IABP
Intra-aortic balloon pump. used to increase oxygen supply and decrease oxygen demand on the heart.
Inflates at the start of diastole and deflates just before systole.
VAD
Ventricular assist device
Bridge to transplant, LVAD, RVAD, BiVAD
Revascularzation
Percutaneous coronary intervention (PCI) via cardiac cath
Angioplasty of coronary artery done in the cath lab
Vasoastive Medications
Vasopressors
Inotropes
Vasopressors
Vasoconstriction
Ensure adequate BP
Dopamine
Norepinephrine (Levophed)
Inotropes
Increase Contractility
Dobutamine and dopamine
Other meds used
Morphine
Diuretics
Meds for MI
Morphine
Decreases myocardial O2 demand
Diuretics
Used with caution so you don’t lose too much fluid
Epi
Not used because it uses too much myocardial oxygen
Nursing interventions
Vasopressors and inotropic medications
Fluid resuscitation
Diuretics and intubation
Labs, ECG, echo, CXR, ABGs
Support
High growlers to decrease venous return to weak heart
Venous return
Increased because the left and right ventricles are too weak to contract adequately, and fluids back up from the right atrium into the venous system which cause peripheral edema and increase fluids in the venous system
