Cardiogenic Shock Flashcards by Diana Hallis

What is cardiogenic shock?

a condition where your heart can’t pump enough blood to meet your body’s needs

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What is the most likely cause of cardiogenic shock?

It is most often caused by a severe heart attack

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What are the first three things that happen during the cardiogenic shock cycle?

*Cardiac output decreases.
*Hypotension ensues.
*Heart rate increases to compensate for hypotension.

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Once the heart rate increases to compensate for hypotension, what happens next during cardiogenic shock?

*Peripheral vasoconstriction occurs.
*Blood is redirected away from the gut.

Chemicals released by dying cells cause further suppression of myocardial function and increase vasoconstriction centrally

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When the heart must work harder, what is increased?

oxygen demand

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How does cardiogenic shock end a person’s life?

Vital organs such as the brain, kidneys, and lungs are hypoperfused causing permanent damage

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Hypoperfusion to the heart and lungs can cause what symptoms?

· Rapid breathing
· Severe shortness of breath
· Sudden, rapid heartbeat (tachycardia)

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what neurological symptoms might be seen? Why?

· Confusion
· Loss of consciousness or fainting

Hypoperfusion to the brain

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What symptoms may indicate poor perfusion in cardiogenic shock?

· Weak pulse
· Sweating
· Pale skin
· Cold hands or feet

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What might the patient tell you they are feeling?

· Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
· Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
· Increasing episodes of chest pain
· Prolonged pain in the upper abdomen
· Impending sense of doom
· Fainting
· Nausea and vomiting

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Other than an MI, what are other causes of cardiogenic shock?

Myocarditis
Endocarditis
Drug abuse
Poisoning

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What are the most severe outcomes of cardiogenic shock?

A large section of heart muscle that no longer moves well or does not move at all ·Breaking open (rupture) of the heart muscle due to damage from the heart attack · Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia

· Pressure on the heart due to a build up of fluid around it (pericardial tamponade)

· Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve

· Tear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers)

· Very slow heart rhythm (bradycardia) or problem with the electrical system of the heart (heart block)

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This is a buildup of fluid around the heart

pericardial tamponade

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What is myocarditis?

Inflammation of the heart muscle

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What are 3 risk factors of cardiogenic shock

previous MI
being 65 years or older
CAD

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What is the initial mangement of cardiogenic shock?

Initial management includes fluid resuscitation to correct hypovolemia and hypotension

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What is the exception to the initial management of cardiogenic shock?

If pulmonary edema is present

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What is required to know if your patient has pulmonary edema?

swan ganz

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What is routine in a patient who is admited for cardiogenic shock?

Central venous and arterial lines are often required. Swan-Ganz catheterization and continuous percutaneous oximetry are routine

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Because oxygenation and airway protection are critical, what may be required?

Intubation and mechanical ventilation

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How can intubation cause harm to a patient in cardiogenic shock?

positive pressure ventilation may improve oxygenation, it may also compromise venous return, preload, to the heart

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What are 3 drips used to combat hypotension during cardiogenic shock?

Dopamine, norepinephrine, and epinephrine

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What is the mean blood pressure required for adequate splanchnic and renal perfusion?

MAP of 65

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What type of catheter may be helpful in guiding fluid resuscitation in situations in which LV preload is difficult to determin

pulmonary artery catheter (swan ganz)

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Cardiogenic shock may be indicated by a cardiac index of less than...

1.8-2.2 L/min/m2

What is a normal cardiac index?

2.5-4

What is a cardiac index?

The cardiac index (CI) is an assessment of the cardiac output value based on the patient's size

How is cardiac index calculated?

divide the cardiac output by the person's body surface area (BSA)

What monitoring system would show you your patient's CI (cardiac index)?

Swan Ganz

Cardiogenic shock may be indicated by a pulmonary capillary wedge pressure greater than...

15-18 mm Hg

What is a normal pulmonary capillary wedge pressure?

4-12 mm Hg

What does an elevated pulomary capillary wedge pressure (PCWP) indicate?

severe left ventricular failure or severe mitral stenosis

What is stroke volume index?

Stroke volume index is the volume of blood pumped by the heart with each beat (in milliliters) divided by the body surface area (square meters)

What is a normal SVI?

35-65mL/m2.

What is Left ventricular stroke work index?

a beat-by-beat assessment of myocardial systolic and diastolic function that integrates systemic hemodynamics to produce a comprehensive measure of cardiac performance

Why would a cardiogenic shock patient require strict I&Os?

To measure kidney function

What labs might be ordered?

BMP, RFP, CBC, cardiac enzymes, abg, lactate, bnp

List 3 reasons why a CBC would be helpful in a patient experiencing cardiogenic shock.

A complete blood count (CBC) is generally helpful to exclude anemia. A high white blood cell (WBC) count may indicate an underlying infection platelet count may be low because of coagulopathy related to sepsis

The diagnosis of acute myocardial infarction (MI) is aided by a variety of serum markers, which include creatine kinase and its subclasses...

troponin, myoglobin, and LDH.

Which cardiac enzyme is the most specific to MI?

The value for the isoenzyme of creatine kinase with muscle and blood subunits is most specific

Creatine kinase may be falsely elevated in people with what conditions?

myopathy, hypothyroidism, renal failure, or skeletal muscle injury.

The rapid release and metabolism of ____ occurs in persons with MI

myoglobin

A ____ rise of myoglobin over 2 hours appears to be a test result that is sensitive for MI.

The serum LDH value increases approximately ___s after the onset of MI,

10 hours

The serum LDH value peaks at ___ after the onset of an MI

peaks at 24-48 hour

The serum LDH value gradually returns to normal in ___ after onset of MI

6-8 days

Which 2 cardiac troponins are commonly used for the diagnosis of myocardial injury?

T and I

Troponin elevation in the absence of clinical evidence of ischemia should prompt...

a search for other causes of cardiac damage, such as myocarditis

Troponin I and T can be detected in serum within ___ after onset of acute MI

a few hours

When do troponin levels peak?

14 hours after MI AND several days later

What is the second troponin peak called?

biphasic peak

How long do troponins remain abnormal?

up to 10 days

Troponin T can be used as a patient risk-stratifying tool in patients with

unstable angina or non–Q-wave MI

ABG: A base deficit elevation (reference range is ___) correlates with the occurrence and severity of shock.

+3 to -3 mmol/L

ABG: A base deficit is also an important marker to follow during

resuscitation of a patient from shock.

Elevated lactate values in a patient with signs of hypoperfusion indicate a poor prognosis; rising lactate values during resuscitation portend a ...

very high mortality rate.

Brain natriuretic peptide (BNP) may be useful as an indicator of ...

congestive heart failure and as an independent prognostic indicator of survival

A low BNP level may effectively ___ cardiogenic shock in the setting of hypotension

rule out

an elevated BNP level does not __ cardiogenic shock

rule in

An echocardiogram can help identify

whether an area of your heart has been damaged by a heart attack and isn't pumping normally.

Coronary catheterization (angiogram). This test can show

if your coronary arteries are narrowed or blocked

What happens during an angiogram (aka heart cath)

A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's pushed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage

During a cardiac cath, what procedure can also be done?

Angioplasty

Angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to...

widen the blocked area. In most cases, a mesh tube (stent) is also placed inside the artery to hold it open more widely and prevent re-narrowing in the future.

What 2 medical PROCEDURES may occur in a patient with cardiogenic shock?

angioplasty or balloon pump

What does a balloon pump do?

The balloon pump inflates and deflates to mimic the pumping action of the heart, helping blood flow through

What are surgeries that can help fix cardiogenic shock?

CABG, surgical repair of tear or valve, LVAD, or heart transplant