Cardiogenic Shock

Question 1

What is a cardiogenic shock?

Answer 1

A state of inadequate tissue perfusion primarily ue to cardiac dysfunction.

It may occur suddenly, or chronically due to worsening heart failure.

Question 2

Causes of cardiogenic shock.

Answer 2

MI

Arrhythmias

PE

Tension pneumothorax

Cardiac tamponade

Myocarditis

Valve destruction

Aortic dissection

Question 3

Management algorithm of cardiogenic shock.

Answer 3

1st - Oxygen and titrate to 94-98%, 88-92% if CO2 retention

2nd - Diamorphine 1.25-5mg IV for pain and anxiety

3rd - Investigations and close monitoring

4th - Correct arrhythmias, U&E abnormalities or acid-disturbance.

5th - Optimise filling pressure with clinical assessment of pulse, BP, JVP/CVP.

6. 1 - Underfilled -> Give a plasma expander 100 ml every 15 min IV. Aim for MAP 70 mmHg, CVP 8-10 mmHg.
7. 2 - Well/Overfilled -> Inotropic support like dobutamine 2.5-10 micrograms/kg/min IVI. Aim for MAP 70mmHg.

7 - Look for and treat any reversible cause.

Question 4

Investigations done in cardiogenic shock.

Answer 4

ECG

U&Es

Troponin

ABG

CXR

Echocardiogram

Question 5

Monitoring in cardiogenic shock.

Answer 5

CVP

BP

ABG

ECG

Urine output

Keep on cardiac monitor/telemetry

Consider a CVP line and an arterial line to monitor pressure.