Cardiogenic shock

Question 1

is the failure of the heart to pump blood adequately to meet the oxygenation needs of thebody.

Answer 1

Cardiogenic shock

Question 2

t occurs when the heart muscle loses its
contractile power. It most commonly occurs as a result of acute myocardial infarction (AMI), and left ventricular pump failure is the primary result.

Answer 2

Cardiogenic shock

Question 3

Etiology

Answer 3

Persistent hypotension
Impaired contractility
Decreased CO
Lack of bld and O2 to the heart muscle
MI
Mechanical complications

Question 4

It is the most common cause of death in the post-AMI patient (about 5% to 10% of AMI patients develop cardiogenic shock),with a resulting mortality of 50% to 60%.

Answer 4

Cardiogenic shock

Question 5

with a marked systolic of less than 80 to 90 mm Hg or mean arterial pressure 30 mm Hg lower than baseline because of left ventricular failure.

Answer 5

Persistent hypotension

Question 6

results in a lack of blood and oxygen to the heart as well as other vital organs (brain and kidneys).

Answer 6

Decreased CO

Question 6

causes a marked reduction in CO and ejection fraction

Answer 6

Impaired contractility

Question 7

results in continued damage to the muscle, a further decline in contractile power, and a continued inability of the heart to provide blood and oxygen to vital organs.

Answer 7

Lack of blood and oxygen to the heart muscle

Question 8

causing extensive damage (40% or greater) to the left ventricular myocardium is the most common
cause

Answer 8

MI

Question 9

such as ventricular septal rupture.contained free wall rupture, and papillary muscle rupture are strongly suspected in patients with shock, particularly a first MI

Answer 9

Mechanical complications

Question 10

Clinical manifestations

Answer 10

*Confusion, restlessness, mental lethargy due to poor brain perfusion.
*Low blood pressure (systolic <90 mm Hg or MAP <65 mm Hg).
*Oliguria (urine output <30 ml/hour).
*Cold, clammy skin; mottled extremities.
*Weak, thready pulses; fatigue; hypotension.
*Dyspnea, tachypnea, cyanosis from pulmonary congestion.
*Dysrhythmias and sinus tachycardia due to oxygen deficiency in the heart.
*Chest pain from inadequate blood supply to heart muscle.
*Decreased bowel sounds, nausea, or abdominal pain from decreased GI perfusion.
*Metabolic acidosis from increased lactate due to anaerobic metabolism.
*Catecholamine release from hypoperfusion increases myocardial oxygen demand and arrhythmia risk.

Question 11

Altered hemodynamic parameters:

Answer 11

*PAWP ≥ 15 mm Hg
*Cardiac index (CI) < 2.0
*Elevated systemic vascular resistance (SVR)
*Right ventricular end-diastolic pressure (RVEDP) > 20 mm Hg
*Decreased mixed venous oxygen saturation

Question 12

Shows pulmonary vascular congestion.

Answer 12

Chest xray

Question 13

Abnormal lab values:

Answer 13

*Elevated blood urea nitrogen (BUN) and creatinine
*Elevated liver enzymes
*Increased prothrombin time (PT) and partial thromboplastin time (PTT)
*Elevated serum lactate
*Elevated brain natriuretic peptide (BNP)
*Elevated cardiac enzymes

Question 14

Displays acute injury pattern consistent with acute myocardial infarction (AMI).

Answer 14

ECG

Question 15

Reveals ventricular wall motion abnormalities or correctable causes (e.g., valvular dysfunction, tamponade).

Answer 15

Doppler echocardiogram

Question 16

Necessary for severely hypotensive patients.

Answer 16

Pulmonary artery catheterization

Question 17

Mgt

Answer 17

*Focus on early revascularization and thrombolystics
*cardiac output augmentation for cardiogenic shock from AMI.
*Use IABP for output support until revascularization.
*Provide mechanical ventilation as needed.
*Consider LVADs and ECMO if necessary.
*Standard treatments may worsen hypotension in cardiogenic shock.

Question 18

Pharmacologic Therapy

Answer 18

*positive inotropic drugs (epinephrine, dopamine, dobutamine, amrinone,milrinone)
*Vasodilator therapy
*Vasopressor therapy
*Diuretic therapy

Question 19

may lower BP because of vasodilatory effect.

Answer 19

Dobutamine, amrinone, and milrinone

Question 20

Decreases the workload of the heart by reducing venous return and lessening the resistance against which the heart pumps (preload and afterload reduction).

Answer 20

Vasodilator therapy

Question 20

may be needed to maintain adequate perfusion pressure (MAP 70 mm Hg or greater). These medications are norepinephrine, epinephrine,
vasopressin, and phenylephrine. These should be used in the lowest possible dose.

Answer 20

Vasopressor therapy

Question 20

Co improves, left ventricular pressures and pulmonary congestion decrease, and myocardial oxygen consumption is reduced.

Answer 20

Vasodilator therapy

Question 21

is used to reduce plasma volume and peripheral edema.

Answer 21

Diuretic therapy

Question 22

Reperfusion Therapy

Answer 22

Percutaneous cardiac interventions
Thrombolytics

Question 23

Prompt restoration of blood flow can lead to improved left ventricular function, thus salvaged ischemic myocardium. Timing of revascularization less than 90 minutes of door-to-door angioplasty after onset of symptoms
provides better survival rates of CS patients.

Answer 23

PCI

Question 24

use of fibrinolytic drugs lead to improved left ventricular systolic function and survival in patients with myocardial infarction associated with either ST-segment elevationor left bundle-branch block.

Answer 24

Thrombolytics

Question 25

Counterpulsation therapy

Answer 25

□lmproves blood flow to the heart muscle and reduces myocardial oxygen needs.
□Results in improved CO (1.5 L/minute increase) and
preservation of viable heart tissue.
□Should be instituted as quickly as possible to increase survival because of its overall benefits.

Question 26

Emergency Cardiac Surgery

Answer 26

Bypass graft
Heart transplantation

Question 27

Complications

Answer 27

□Neurologic impairment/stroke.
□Acute respiratory distress syndrome.
□Renal failure.
□Cardiopulmonary arrest.
ODysrhythmia.
□ventricular aneurysm.
□Multiorgan dysfunction syndrome.
□Bowel ischemia.
□Limb ischemia.
ODeath.

Question 27

Nsg assessment

Answer 27

*Begin clinical assessment with ABCs (airway, breathing, circulation) and vital signs.
*Assess for early shock signs: restlessness, confusion, increased HR, decreased BP, and pulse pressure.
*Look for pulsus alternans (left-sided heart failure), decreased urine output, weakness, and fatigue.
*Observe central/peripheral cyanosis, edema, and cool extremities.
*Monitor for MI extension: chest pain, diaphoresis.
*Identify patient’s and family’s reaction to crisis.

Question 28

Nsg interventions

Answer 28

*Administer oxygen and adjust flow based on blood gas levels.
*Give diuretics cautiously to increase renal blood flow and urine output.
*Monitor BP, pulse, RR, and peripheral pulse every 1-5 minutes until stable.
*Track ABG, CBC, and electrolyte levels.
*Provide rest to ease emotional stress.
*Allow family visits for patient comfort.
*Assess skin for cold, clammy signs of shock.