Cardiogenic Shock

Question 1

What is Cardiogenic Shock?

Answer 1

Cardiogenic shock, also known as cardiac shock, happens when your heart cannot pump enough blood and oxygen to the brain and other vital organs. This is a life-threatening emergency. It is treatable if diagnosed right away, so it’s important to know the warning signs.

Common Cause: Acute MI or HF

Question 2

How do you assess for Cardiogenic Shock?

Answer 2

ABCDE
1. Cardiac Exam
2.ECG, CXR blood test
3. serum natriuretic peptides (B‑type natriuretic peptide [BNP] or N‑terminal pro‑B‑type natriuretic peptide [NT‑proBNP]) and the following thresholds to rule out the diagnosis of heart failure:

BNP less than 100 ng/litre

NT‑proBNP less than 300 ng/litre.

Question 3

What treatments are used for the management of cardiogenic shock?

Answer 3

MI: Angioplasty and possibly a stent placement to help blood get through a blood vessel with a buildup of plaque (cholesterol and fat).

valve problem: Heart valve repair or replacement.
Cardiac Fluid Tamponade: A procedure that uses a needle to remove excess fluid compressing your heart.

several blocked coronary arteries: Coronary artery bypass graft (open heart surgery) to help more blood get to your heart.

If your heart remains too sick despite other treatments, you may require a machine that temporarily takes the workload from your heart and lungs (ECMO or extracorporeal membrane oxygenation). In addition to ECMO, placing a temporary pump in your aorta can help your heart pump more blood.

If your heart function isn’t expected to improve, your healthcare team may evaluate you for a left ventricular assist device (LVAD, a long-term device to support your heart) or a heart transplant.

Question 4

What are the treatment and medications used for cardiogenic shock?

Answer 4

treatment that begins in a hospital emergency room or intensive care unit may include:

Medications given through an IV to help remove excess fluid, improve blood flow, and support your heart function.
Oxygen to help your breathing.
Placement of a temporary monitoring line called a Swan-Ganz catheter, which is a special catheter that monitors the pressures inside your heart. This can help your healthcare team to closely follow your response to treatment. Medicines may include:

Nitroprusside (Vasodilator that lowers BP and improves cardiac output)
Norepinephrine (Vasopressor catelochomine hormone to improve BP)
Epinephrine (improve BP but MORE for increasing HR)
Dobutamine. (Vasodilator to increase cardiac output and increase BP)
Dopamine. (Increase contractility, HR and output)
Milrinone. (improves cardiac contractility (inotropy) and cardiac relaxation (Lusitropy) and induces vasodilation)
Furosemide (can decrease fluid overload when cardiac output is increased/ pulmonary congestion)
Vasopressin (improve perfusion to vital organs by increasing systemic vascular resistance (vasoconstriction) and therefore mean arterial pressure)