Cardiogenic Shock Flashcards
What is the definition of shock?
Profound reduction in devlivery of O2 and other nutrients to tissues leads first to REVERSIBLE and then if prolonged to IRREVERSIBLE cell injury
What are the 4 forms of shock?
Cardiogenic
Extracardiac (obstructive)
Hypovolemic
Distributive (septic)
What is the clinical diagnosis of shock?
<90 mm Hg systolic
PLUS
Poor perfusion (CNS = confusion, Skin = cold, clammy)
What are the 3 types of cardiogenic shock?
Large LV MI
RV MI
MR os VSD
What is the definition of filling pressure?
Pressure the atrium must rise to fill the ventricle
aka ventricular end diastolic pressure
How can you measure the filling pressures of the RV and LV?
Swan-Ganz pulmonary artery flotation catheter
What is a normal LV EDP?
<12 mmHg
What is a normal RV EDP?
<5 mmHg
How can the Swan Ganz catheter measure LV EDP?
Floats through RA, RV, to pulmonary capillaries
Blocks capillary and tip measures pressure
This pressure = LA pressure = LV EDP
What is a normal CO?
3.5 - 5.0 L/min
When there is a large LV MI, what happens to the following characteristics:
- LV EDP
- RV EDP
- CO
- Murmur (y/n)
LV EDP - increased
RV EDP - no change
CO - decreased
Murmur - No
In Large LV MI, systolic function (pump function) is bad
What is the prognosis for a patients with large LV MI?
> 90% mortality
What are two ways that the myocardial tissue can “act dead”?
Stunning - blood has reperfused tissue, requires time for muscle to start working again
Hibernating - blood has not yet reperfused
What are ways of maintaining viability of “acting dead” tissue?
Inotropic support
Vasopressors
Mechanical devices - best option
Which drugs can be used to provide inotropic and vasopressor support to try and maintain perfusion in large LV MI?
Dopamine - best option, positive inotrope and causes vasoconstriction
NE - potent vasopressor, give if dopamine inadequate
Dobutamine - should not be used if patient is hypotensive! Causes vasodilation