cardiogenic shock

Question 1

What is cardiogenic shock?

Answer 1

Ability to pump blood is impaired and the supply of oxygen to the heart is inadequate

Question 2

What are coronary and noncoronary causes for cardiogenic shock?

Answer 2

MI
Stress to myocardium (hypoxemia, acidosis, hypoglycemia, hypocalcemia, tension pneumothorax)
Cardiomyopathies
Valvular damage
Cardiac tamponade
Dysrhythmias

Question 3

What is the pathophysiology of cardiogenic shock?

Answer 3

Impaired tissue perfusion weakens the heart and impaired its ability to pump
Lowered ejection fraction
Fluid accumulates in the lungs

Question 4

What are the clinical manifestations of cardiogenic shock?

Answer 4

Angina
Dysrhythmias
Fatigue
Impending sense of doom
Hemodynamic instability

Question 5

What is the medical management of cardiogenic shock?

Answer 5

Increasing cardiac contractility
Decreasing ventricular afterload
Correction of underlying causes

Question 6

What is the first line treatment for cardiogenic shock?

Answer 6

Oxygen NC 2-6 L/ min to bring o sat above 90%
Morphine for pain control
Hemodynamic monitoring
Monitoring of labs (BNP, cardiac enzymes, ECG)
Fluid therapy

Question 7

What does dobutamine do for cardiogenic shock?

Answer 7

Inotropic: increasing the strength of contractility
Decrease pulmonary and systemic vascular resistance

Question 8

hat does low-dose nitroglycerin do for cardiogenic shock?

Answer 8

Venous vasodilation and reduced preload

Question 9

What does high-dose nitroglycerin do for cardiogenic shock?

Answer 9

Arterial vasodilation, reduced afterload, and improved blood flow to the myocardium

Question 10

What does dopamine do for cardiogenic shock regardless of dose?

Answer 10

Used with nitroglycerin, it can improve tissue perfusion

Question 11

What does low-dose dopamine do for cardiogenic shock?

Answer 11

improves cotractility
2-8 𝛍g/kg/min

Question 12

What does high-dose dopamine do for cardiogenic shock?

Answer 12

At >8 𝛍g/kg/min, it causes vasocontriction
Not desirable, titrate carefully

Question 13

What do we use antiarrhythmic medications for in cardiogenic shock?

Answer 13

Stabilize heart rate

Question 14

What are medical assistance devices we use for cardiogenic shock?

Answer 14

ntra aortic balloon pump
Left and right ventricular assist devices
Total temporary artificial hearts
Cardiopulmonary bypass system