Cardiogenic shock book

Question 1

occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and the tissues

Answer 1

Cardiogenic shock

Question 2

The causes of cardiogenic shock are known as either

Answer 2

Coronary or non coronary

Question 3

is more common and seen most often in patients with acute MI resulting in damage to a significant portion of the left ventricular myocardium

Answer 3

Coronary cardiogenic shock

Question 4

Patients who experience an….are at greatest risk for cardiogenic shock because of the potentially extensive damage to the left ventricle caused by occlusion of the left anterior descending coronary artery

Answer 4

Anterior wall MI

Question 5

causes of cardiogenic shock are related to conditions that stress the myocardium (e.g., severe hypoxemia, acidosis, hypoglycemia, hypocalcemia, tension pneumothorax) as well as conditions that result in ineffective myocardial function (e.g., cardiomyopathies, valvular damage, cardiac tamponade, arrhythmias)

Answer 5

Non coronary

Question 6

In cardiogenic shock, cardiac output, which is a function of .. and.. is compromised

Answer 6

Stroke volume and heart rate

Question 7

When stroke volume and heart rate decrease or become erratic..

Answer 7

BPmfalls
Tissue perfusion is reduced

Question 8

Clinical manifestations

Answer 8

Angina
Arrhythmias
Fatigue
Feeling of doom
Hemodynamic instability

Question 9

Dx findings

Answer 9

B-type natriuretic peptide
cardiac enzyme le els and biomarkers (cTn-I)
Serum lactate
ECG and ST segment monitoring

Question 10

Medical mgt

Answer 10

Correction of Underlying Causes
Initiation of First-Line Treatment

Question 11

In case of CORONARY cardiogenic shock pt may require

Answer 11

thrombolytic (fibrinolytic) therapy,
percutaneous coronary intervention
coronary artery bypass graft surgery,
IABP therapy,
ventricular assist device

Question 12

In case of NONCORONARY cardiogenic shock pt may require

Answer 12

replacement of an impaired cardiac valve,
correction of an arrhythmia
correction of acidosis and electrolyte disturbances
or treatment of a tension pneumothorax.

Question 13

If the cause of the cardiogenic shock was related to a cardiac arrest, once the patient is successfully resuscitated, targeted temperature management, also called

Answer 13

therapeutic hypothermia

Question 14

First line tx

Answer 14

Oxygen
Pain control
Hemodynamic monitoring
Fluid therapy
Pharmacologic Therapy

Question 15

may be inserted to allow measurement of myocardial filling pressures, pulmonary artery pressures, cardiac output, and pulmonary and systemic resistance.

Answer 15

multilumen CVP and PA catheter

Question 16

are cautiously given to determine optimal filling pressures for improving cardiac output

Answer 16

Incremental IV fluid boluses

Question 17

Pharmacologic Therapy

Answer 17

Dobutamine
Nitroglycerin
Dopamine
Vasoactive medication
Antiarrhythmic medications
Mechanical assistive devices

Question 18

increase cardiac output by mimicking the action of the sympathetic nervous system, activating myocardial receptors to increase myocardial contractility

Answer 18

Inotropic medications

Question 19

increase myocardial contractility

Answer 19

Inotropic action

Question 20

increasing the heart rate

Answer 20

Chronotropic action

Question 21

are used primarily to decrease afterload, reducing the workload of the heart and oxygen demand.

Answer 21

Vasodilator

Question 22

produces inotropic effects by stimulating myocardial betareceptors, increasing the strength of myocardial activity and improving cardiac output

Answer 22

Dobutamine

Question 23

are also stimulated, resulting in decreased pulmonary and systemic vascular resistance

Answer 23

Myocardial alpha-adrenergic receptors

Question 24

in low doses acts as a venous vasodilator and therefore reduces preloa

Answer 24

IV nitroglycerin

Question 25

is a sympathomimetic agent that has varying vasoactive effects depending on the dosage

Answer 25

Dopamine

Question 26

Nursing mgt

Answer 26

Preventing Cardiogenic Shock
Monitoring Hemodynamic Status
Administering Medications and Intravenous Fluids
Maintaining Intra-Aortic Balloon Counterpulsation
Enhancing Safety and Comfort