Cardiogenic shock

Question 1

Risk Factors for Cardiogenic Shock

Answer 1

1 Elderly
2 Female
3 Acute or prior ischemic event associated with the following:
Impaired ejection fraction
Extensive infarct (evidence of large myocellular leak)
Proximal left anterior descending coronary artery occlusion
Anterior myocardial infarction location
Associated with multivessel disease
4 Prior medical history
Previous myocardial infarction
Congestive heart failure
Diabetes

Question 2

Causes of Cardiogenic Shock

Answer 2

1 Acute myocardial infarction 
  Pump failure
  Mechanical complications
    Acute mitral regurgitation secondary to papillary muscle rupture
    Ventricular septal defect
    Free-wall rupture
2 Right ventricular infarction 
3 Severe depression of cardiac contractility 
  Sepsis
  Myocarditis
  Myocardial contusion
  Cardiomyopathy
4 Mechanical obstruction to forward blood flow 
  Aortic stenosis
  Hypertrophic cardiomyopathy
  Mitral stenosis
  Left atrial myxoma
  Pericardial tamponade
5 Regurgitation of left ventricular output 
  Chordal rupture
  Acute aortic insufficiency

Question 3

Differential Diagnosis of Cardiogenic Shock

Answer 3

Acute myocardial infarction
Pulmonary embolus
Chronic obstructive pulmonary disease exacerbation
Pericarditis
Myocarditis
Aortic dissection
Pericardial tamponade
Acute valvular insufficiency
Sepsis
Hemorrhage
Toxins/drugs of abuse

Question 4

Chest Xray findings of cardiogenic shock

Answer 4

1 pulmonary congestion or edema, 
2 Kerley lines,
3 increased pulmonary vascularity,
4 alveolar infiltrates, 
5 pleural effusion
6 cardiomegaly

Question 5

Best tool to detect a mechanical catastrophe

Answer 5

Echocardiography

Question 6

We can provide temporary airway support to cooperative patients with cardiogenic shock using … or …

Answer 6

CPAP or BiPAP

Question 7

…. is contraindicated in cardiogenic shock

Answer 7

Beta-blocker

Question 8

… are generally contraindicated, because they increase cardiac afterload without augmenting cardiac contractility.

Answer 8

Alpha1-adrenergic receptor agonists, such as phenylephrine,

Question 9

In the absence of profound hypotension, …. is a mainstay of initial pharmacologic treatment.

Answer 9

Dobutamine 2-5 micrograms/kg per minute, titrated up to 20 micrograms/kg per minute

Question 10

With systolic BP

Answer 10

dopamine 3-5 micrograms/kg per minute, titrated up to 20-50 micrograms/kg per minute as needed

dobutamine

Question 11

In acute mitral regurgitation, hemodynamic support can be initiated with… and…..

Answer 11

dobutamine

nitroprusside

Question 12

Survival from cardiogenic shock is highest with …, followed by … with … therapy

Answer 12

emergency coronary intervention

intra-aortic balloon pump combined

thrombolytic

Question 13

In cardiogenic shock, ….that is, …. or ….is the treatment of choice.

Answer 13

early revascularization

percutaneous coronary intervention (angioplasty)

coronary artery bypass graft