Cardiogenic Shock, Orthostatic Hypotension, & Syncope Flashcards
what is the most common cause of cardiogenic shock?
Acute MI
clinical condition of inadequate tissue perfusion due to the inability of the heart to pump an adequate amount of blood
cardiogenic shock
what is the most common presentation of cardiogenic shock?
severe dysfunction of the LV (anterior MI)
what do a majority of patients with cardiogenic shock present with on ECG?
acute STEMI
what are 2 major risk factors for cardiogenic shock?
ST elevation MI
left BBB
a patient presents with hypotension, oligura, cold clammy skin, and metabolic acidosis on labs. what are they likely experiencing?
cardiogenic shock
what changes in labs will indicate metabolic acidosis in cardiogenic shock? (2)
elevated lactate
decreased serum bicarbonate
what lab values will indicate renal hypoperfusion in cardiogenic shock? (2)
elevated blood urea nitrogen + creatinine
what diagnostic can be done for suspected cardiogenic shock if diagnosis remains unclear?
pulmonary artery catheterization
what is the medical treatment for cardiogenic shock? (3)
ventilatory support (raise pH)
norepi + dopamine for hypotension
what inotrope can be used in less sick patients for cardiogenic shock?
dobutamine
what is the mechanical treatment for cardiogenic shock in the presence of mechanical defects like MR or ventricular septal defect?
intra-aortic balloon pump
what are 3 treatments that can be used for cardiogenic shock to encourage reperfusion?
primary percutaneous coronary intervention
CABG
fibrinolysis
a significant reduction in BP upon standing; dropping 20 systolic or 10 diastolic, 3 mins after standing
orthostatic hypotension
in patients with orthostatic hypotension, a _____ _____ fails, leading to a decline in BP with assumption of upright posture
compensatory mechanism
what are 2 risk factors for orthostatic hypotension?
elderly
antihypertensive (side effect)
a patient presents with coat hanger headache, dizziness, and weakness. what are they likely experiencing?
orthostatic hypotension
what are 3 lifestyle modifications to treat orthostatic hypotension?
elastic stockings
raise head of bed
exercise
what are 3 physical maneuvers to treat orthostatic hypotension?
increase salt + water intake
cross legs while standing
handgrip while standing
what is the primary goal of treatment of orthostatic hypotension?
decrease symptoms
what are 2 medications that can be used for orthostatic hypotension?
fludrocortisone
milodrine
what medication can be used for orthostatic hypotension that is associated with meals?
octreotide
abrupt and transient loss of consciousness associated with the absence of postural tone, followed by complete and rapid spontaneous recover
syncope
patients with an underlying _____ cause of syncope have higher rates of SCD
cardiovascular
what is the underlying mechanism in all syncope events?
cerebral hypoperfusion
what is the mnemonic for etiologies of syncope?
Pressure
Arrhythmias
Seizures
Sugar
Output
Unusual
Transient
what is the most common type of syncope?
reflex syncope
causes vasovagal syncope due to stimuli triggering sudden vasodilation and bradycardia, resulting in hypotension
pressure
causes sudden syncope with no warning + loss of consciousness
arrhythmias
what is the difference between a seizure and syncope?
seizure patients have prolonged confusion/lethargy after seizure + aura
what is the gold standard of diagnosing a seizure?
history
what are 3 unusual causes of syncope?
anxiety
panic disorder
somatization disorder
what are 3 transient causes of syncope?
stroke
transient ischemic attack (TIA)
subarachnoid hemorrhage
Predicts risk for serious outcomes at 7 days in patients presenting with syncope or near-syncope
san francisco syncope rule
what are the 5 parts of the san francisco syncope rule?
hx of CHF
hematocrit <30%
abnormal ECG
SOB
systolic BP <90 at triage
what are 2 meds that can be used for syncope?
midodrine
fludricortisone
what is the single most common cardiac cause of syncope?
bradycardia
