cardiogenic shock

Question 1

coronary etiology

Answer 1

Infarction or ischemia causing 40% or more of cardiac muscle damage
Anterior wall MI
Papillary muscle rupture
Ventricular wall or septal rupture
Cardiomyopathy
Aortic stenosis

Question 2

non-cornonary etiology

Answer 2

Cardiac Tamponade
Restrictive pericarditis
Massive pulmonary embolus (PE)
Pulmonary hypertension
Tension pneumothorax

Question 3

noninvasive findings with cardiogenic shock

Answer 3

Rapid, thready pulse
Narrow pulse pressure
Distended neck veins
Arrhythmias
Chest pain
Cool, pale, moist skin
Oliguria
Altered mental status

Question 4

pulmonary findings with cardiogenic shock

Answer 4

Dyspnea
Tachypnea
Crackles
ABGs reveal decreased PaO2, SaO2, PaCO2

Question 5

diagnostic tests for cardiogenic shock

Answer 5

Cardiac enzymes
BNP
Echocardiogram
Coronary angiography

Question 6

hemodynamic profile of a patient in cardiogenic shock

Answer 6

Contractility is impaired
CO/CI is low (CI <2.2L/min/m2)
BP is low (SBP <90 mm Hg +MAP <70 mm Hg)

Preload is increased
CVP is high
PCWP is high (> 18 mm Hg)

Afterload is increased
SVR is high

Question 7

medical management of cardiogenic shock

Answer 7

Inotropes
Nitrates-
Diuretics-
Opioids-
Vasopressors
Once vasopressors weaned off, afterload reducers may be added

• use with caution -> lowers BP

Question 8

treatment of cardiogenic shock

Answer 8

Early revascularization
IABP (intra-aortic balloon pump)
Left-ventricular assist device (LVAD)
Surgical repair
Transplantation

Question 9

goals and benfits of IABP therapy

Answer 9

To decrease myocardial workload by improving myocardial supply and decreasing myocardial demand
- Increases perfusion of coronary arteries
- Reduces afterload, thus decreasing the workload of the LV

Additional benefit: Enhances perfusion of renal and mesenteric arteries

Question 10

what does an IABP not do

Answer 10

Does NOT measure hemodynamic parameters (except for BP)
Is NOT a pacemaker or a VAD (ventricular assist device)

Question 11

nursing interventions r/t IABP

Answer 11

HOB < 30 degrees
Monitor pedal pulses
Monitor LOC, U/O, L radial pulse
Flush arterial line q 1 hr
Monitor site frequently for bleeding

Question 12

what medication is appropriate treatment for cardiogenic shock?

A beta 1 agonist
A beta 1 antagonist

Answer 12

A beta 1 agonist

Question 13

which of the following is a positive inotrope?

Metoprolol
Diltiazem
Nitroprusside
Dobutamine

Answer 13

Dobutamine