Cardiogenic shock Flashcards
What can lead to cardiogenic shock
►Myocardial infarction ►Dysrhythmias ►End-stage congestive heart failure ►Cardiomyopathy ►Myocarditis / Endocarditis ►Valvular diseases / structural disorders
What happens to Filling pressures and BP in cardiogenic shock
Persistent hypotension (systolic blood pressure <80 to 90
mmHg or mean arterial pressure 30 mmHg lower than
baseline)
• Severe reduction in the Cardiac Output (Cardiac Index
<1.8 L/min without support or <2 to 2.2 L/min with
support)
• Adequate or elevated filling pressures
How is oxygen delivery affected in cardiac shock
Oxygen delivery (DO2) is affected by changes in any of its 3 components (Hb, Oxygenation, and CO) and by changes in VO2 (O2 consumption).
What happens in acute anemia/acute hypoxia
In the case of acute anemia or acute hypoxia, the CO increases to maintain normal DO2
Is there compensatory mechanism for acute reduction in CO
there is no compensatory mechanism for acute
reduction in CO.
What happens if there is a drop in CO
Acute reduction in DO2 due to a drop in CO (from AMI) when VO2 is unchanged is ‘‘compensated’’ by greater oxygen extraction (ER), resulting in a drop in mixed venous oxygen saturation (SvO2)
Hemodynamics in cardiogentic shock
CO/EF
CVP/PAOP
SVO2
• CO/EF decreased • Preload (CVP, PAOP) increased • SvO2 decreased hypotension
What happens with the SNS in cardiogenic shock
SNS stimulation= tachycardia
RASS Stimulation in cardiogenic shock
•Increased SVR
• Further difficulty with
ventricular ejection
Cardiac symptoms in cardiogenic shock
- Chest pain
- Tachycardia
- Hypotension
- Decreased peripheral pulses
Respiratory symptoms cardiogenic shock
- SOB
- Dyspnea
- Crackles
Neurological symptoms cardiogenic shock
- Restlessness
* Confusion
GI symptoms in cardiogenic shock
Nausea, Vomiting
Decreased bowel sounds
GU symptoms in cardiogenic shock
Inadequate urinary output
Skin symptoms in cardiogenic shock
- Cool and clammy skin
* Diaphoresis
What happens when Compensatory Mechanisms Fail
-Worsening inadequate organ perfusion • Hypotension • Tachycardia with weak pulses • Tachypnea • Cold, cyanotic, and mottled skin • Decreased or absent urine output • Severely decreased level of consciousness • Severely decreased or absent bowel sounds
Clinical manifestations of cardiogenic shock in late stage
Body systems
Multiple Organ Dysfunction Syndrome
• Cardiac: Severe hypotension, bradycardia
• Respiratory: Hypoxia
• GI: Liver and pancreas failure leading to hypoglycemia*
• GU: Decreased or absent urine output*
• Hematological: Emboli, DIC, Severe coagulopathy
Complications of cardiogenic shock
Cardiopulmonary arrest Dysrhythmias Multisystem organ failure Stroke Thromboembolism
Diagnostic tests for Cardiogenic shock ECG what do you look for
►ECG
• ST elevation
• Q wave
• Metabolic profile – indicators of systems failure (LFTs, RFTs)*
Diagnostic tests for Cardiogenic shock Lab what do you look for
►Laboratory analysis • Increased troponin, CK-MB • Arterial and venous blood gas analysis - hypoxemia with metabolic acidosis (Elevated lactic acid*), and decreased SvO2 • Metabolic profile – indicators of systems failure (LFTs, RFTs)*
Pulmonary artery catheterization/values Cardiogenic shock
- CO decreased
* CVP, PAOP, SVR increased
Echocardiogram
Cardiogenic shock
- Ejection fraction decreased
* Wall motion abnormalities
Emergency medical management of cardiogenic shock
Stabilizing oxygenation
• Oxygen via 100% non-rebreather or Intubation and Mechanical Ventilation
• Hemodynamic monitoring
• BP, CO, preload, afterload, stroke volume, and SVO2
• Vasoactive medication therapy
• to support blood pressure and increase cardiac output
►Pain control
Medication Therapy cardiogenic shock
►Increase contractility – Inotropic drugs • Dobutamine, Milrinone ►Decrease preload and afterload • Nitroglycerine, Nitroprusside, Intravenous Morphine ►Support blood pressure – Vasopressors • Dopamine, Norepinephrine ►Decrease O2 demand and workload • Nitrates, b Blockers ►Diuretics
Medical Management: Procedures & Assistive Devices Cardiogenic shock
►Restore Blood Flow/Emergency Revascularization
• PTCA with stenting
►Intra-Aortic Balloon Pump
• Reduces afterload, improves coronary artery perfusion, improves
perfusion to vital organs
►Ventricular assist device
• External pump that assists the pumping of the left ventricle
►Extracorporeal Membrane Oxygenation (ECMO)
Nursing Management: Care of IABP
►Ensure IABP catheter securement
►HOB < 30 degrees, and the affected leg is kept straight at all times
• Helps avoid catheter migration
►Assess catheter tubing for brown flecks or blood
• Brown flecks may indicate balloon rupture
►Assess lower extremity perfusion such as color, temperature, and
pulses
Surgical Management of cardiogenic shock
►Coronary Artery Bypass Graft
►Replacement of faulty valves
►Artificial heart replacement
►Heart Transplantation
Nursing management of cariogenic shock labs
ABG • Hemoglobin and Hematocrit • Metabolic profile • Lactate • SvO2
Nursing interventions for Cardiac shock
Stabilize oxygenation • 100% NRB • Prepare for intubation ►Monitor hemodynamic status • VS • Arterial line • CVP • PA catheter • Continuous ECG monitoring ►Administer medications and IV fluids ►Prepare for procedures
