Cardiogenic Shock

Question 1

What is cardiogenic shock

Answer 1

Decreased myocardial contraction force causes decreased ejection fraction and described cardiac output

Question 2

What causes cardiogenic shocks

Answer 2

1. Ischemic heart disease and AMI
2. Involves left main or LAD obstruction
3. Requires at least 40% loss of functional myocardium

Question 3

What are other causes of cardiogenic shock

Answer 3

1. Dysrhythmias
2. Cardiomyopathy
3. Valvular disorder
   *associated with a high mortality rate
   *not CHF

Question 4

What is on the PE for cardiogenic shock

Answer 4

1. Hypotension
2. Narrow pulse pressure
3. Tachycardia
4. Tachypnea
5. Cool, clammy skin
6. Peripheral cyanosis
7. Gallop rhythm
8. JVP distention
9. Pulmonary rales

Question 5

What are findings on CXR during cardiogenic shock

Answer 5

1. Cardiomegaly
   *signs of pulmonary venous congestion

Question 6

What are common findings on ECG during cardiogenic shock

Answer 6

1. Non-specific ST segment and T waves changes
2. Dysrhythmias
3. Conduction abnl

Question 7

What are common findings no echo during cardiogenic shocks

Answer 7

1. Enlarged heart with Hypokinetic LV and decreased EF

Question 8

What is found on the Cath during cardiogenic shock

Answer 8

LAD
*left main occlusion
*poor LV function
*reduced EF

Question 9

What is the treatment of cardiogenic shock

Answer 9

1. Continuous monitoring
2. High-flow oxygen or mechanical ventilation
3. Reversal of hypotension: vasopressors
4. Inotropic support
   *drugs to increase myocardial contractility and CO

Question 10

Are fluids given for cardiogenic shock

Answer 10

No
*can do gentle fluid challenge 250CC if no overt pulmonary edema

Question 11

What type of into-tropic drugs are given in cardiogenic shock

Answer 11

1. Dobutamine (positive inotrope)
2. Epi (positive inotrope and vasoconstrictor)