Cardiogenic shock book Flashcards
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
Cardiogenic shock
The causes of cardiogenic shock are known as either
Coronary or non coronary
is more common and seen most often in patients with acute MI resulting in damage to a significant portion of the left ventricular myocardium
Coronary cardiogenic shock
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
Anterior wall MI
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)
Non coronary
In cardiogenic shock, cardiac output, which is a function of .. and.. is compromised
Stroke volume and heart rate
When stroke volume and heart rate decrease or become erratic..
BPmfalls
Tissue perfusion is reduced
Clinical manifestations
Angina
Arrhythmias
Fatigue
Feeling of doom
Hemodynamic instability
Dx findings
B-type natriuretic peptide
cardiac enzyme le els and biomarkers (cTn-I)
Serum lactate
ECG and ST segment monitoring
Medical mgt
Correction of Underlying Causes
Initiation of First-Line Treatment
In case of CORONARY cardiogenic shock pt may require
thrombolytic (fibrinolytic) therapy,
percutaneous coronary intervention
coronary artery bypass graft surgery,
IABP therapy,
ventricular assist device
In case of NONCORONARY cardiogenic shock pt may require
replacement of an impaired cardiac valve,
correction of an arrhythmia
correction of acidosis and electrolyte disturbances
or treatment of a tension pneumothorax.
If the cause of the cardiogenic shock was related to a cardiac arrest, once the patient is successfully resuscitated, targeted temperature management, also called
therapeutic hypothermia
First line tx
Oxygen
Pain control
Hemodynamic monitoring
Fluid therapy
Pharmacologic Therapy
may be inserted to allow measurement of myocardial filling pressures, pulmonary artery pressures, cardiac output, and pulmonary and systemic resistance.
multilumen CVP and PA catheter
are cautiously given to determine optimal filling pressures for improving cardiac output
Incremental IV fluid boluses
Pharmacologic Therapy
Dobutamine
Nitroglycerin
Dopamine
Vasoactive medication
Antiarrhythmic medications
Mechanical assistive devices
increase cardiac output by mimicking the action of the sympathetic nervous system, activating myocardial receptors to increase myocardial contractility
Inotropic medications
increase myocardial contractility
Inotropic action
increasing the heart rate
Chronotropic action
are used primarily to decrease afterload, reducing the workload of the heart and oxygen demand.
Vasodilator
produces inotropic effects by stimulating myocardial betareceptors, increasing the strength of myocardial activity and improving cardiac output
Dobutamine
are also stimulated, resulting in decreased pulmonary and systemic vascular resistance
Myocardial alpha-adrenergic receptors
in low doses acts as a venous vasodilator and therefore reduces preloa
IV nitroglycerin
is a sympathomimetic agent that has varying vasoactive effects depending on the dosage
Dopamine
Nursing mgt
Preventing Cardiogenic Shock
Monitoring Hemodynamic Status
Administering Medications and Intravenous Fluids
Maintaining Intra-Aortic Balloon Counterpulsation
Enhancing Safety and Comfort
