Cardiogenic shock

Question 1

What is cardiogenic shock?

Answer 1

A state of inadequate tissue perfusion primarily due to cardiac dysfunction. May occur suddenly or after progressively worsening heart failure

Question 2

What are the causes of cardiogenic shock?

Answer 2

MI
Arrhythmias
Pulmonary embolism
Tension pneumothorax
Cardiac tamponade
Myocardiatis
Myocardial depression- drugs, hypoxia, acidosis, sepsis
Valve destruction (endocarditis)
Aortic dissection

Question 3

How is cardiogenic shock managed?

Answer 3

1. Oxygen
2. Diamorphine
3. Investigations and close monitoring
4. Correct arrhythmias; U&E abnormalities or acid-base disturbance
5. Optimize filling pressure with clinical assessment of pulse, BP, JVP/CVP. If in ICU consider using PICCO or LIDCO
   6a) If underfilled give a plasma expander- 100ml every 15minutes IV aiming for MAP 70mmHg and CVP 8-10mmHg
   6b) If well/over filled, ionotropic support e.g. dobutamine aiming for MAP 70mmHg
6. Look for and treat any reversible cause MI or PE. Consider thrombolysis or surgery for acute VSD; mitral or aortic incompetence

Question 4

What are PICCO and LIDCO?

Answer 4

PICCO= pulse contour cardiac output and LIDCO= lithium dilution cardiac output. Both use injection (PICCO= cold water; LIDCO= lithium) to estimate filling pressure, extravascular fluid i.e. pulmonary oedema and cardiac output.

Question 5

What is cardiac tamponade?

Answer 5

An acute type of pericardial effusion in which fluid, pus, blood, clots, or gas accumulates in the pericardium resulting in slow or rapid compression of the heart. In essence: pericarial fluid collects, intra-pericardial pressure rises, heart cannot fill?, pumping stops

Question 6

What are the causes of cardiac tamponade?

Answer 6

Trauma
Lung/breast cancer
Pericarditis
Myocardial infarct
Bacteria e.g. TB

Question 7

What are the three main signs of cardiac tamponade? What are these known as?

Answer 7

Falling BP
Rising JVP
Muffled heart sounds

Beck’s triad

Question 8

What is Kussmaul’s sign?

Answer 8

Raised JVP on inspiration

Question 9

What is pulsus paradoxus?

Answer 9

Pulse fades on inspiration

Question 10

How should cardiac tamponade be treated?

Answer 10

Prompt pericardiocentesis brings swift relief. While awaiting this giev oxygen, monitor ECG and set up IVI