cardiogenic Shock

Question 1

What are the symptoms of cardiogenic shock?

Answer 1

Increased HR (tachycardia)
Low BP (hypotension)
Poor urine output(oliguria)
Cold, clammy & cyanosed skin
Rapid breathing (tachypnoea) 
Changed level of consciousness

Question 2

What are the causes of cardiogenic shock?

Answer 2

MI
Cardiac tamponade (accumulation of fluid in pericardium sac)
Left ventricular aneurysm (swelling)
Pulmonary embolism ( blockage in lung artery)
Myocardial contusion (bruising)
Right ventricular pump failure
Dysrhythmias

Question 3

Treatment for cardiogenic shock

Answer 3

Airway/Breathing-15L non-rebreathe to increase perfusion. SATS and ECG monitor, chest X-ray , echocardiogram ( shows size/shape of heart)cardio enzyme test, arterial blood gas, LFT, IV access & CV line/PA catheter to monitor BP .In absence of pulmonary oedema- IV fluid challenge such as colloids (Albimum)
With oedema- in tropic support-Dopamine (increases HR) and dobutamine ( decreases BP)- can be counterproductive.
Treat Dysrhythmias with-adenosine (restores rhythm) atropine (increases HR) and digoxin (slows HR)
Percutaneous coronary intervention-stent to open narrowed artery
Ventricular assist device- battery pump
Bypass-arteries and veins used to bypass narrowed arteries to create a new passage for blood to reach the heart
Cardiac transplant
Intra-aortic balloon pump- placed in aorta mimics heart pumping rhythm.

Thrombolytic- clot busters
Anticoagulants- heparin / aspirin blood thinners

Question 4

What is the pathology of cardiogenic shock?

Answer 4

Inadequate perfusion due to the hearts failure to pump . Decreased cardiac output. Fast HR due to bareceptors notice drop in BP stimulating SNS to vasoconstrict the blood vessels. Epinephrine is released causing vasoconstriction. Increasing SVR causing blood to be redistributed to vital organs. Extremities cold & cyanosed. SVR & renin-aldosterone is activated especially in gastro/ renal/ skeletal muscle causing sodium & water retention in attempt to increase BP.