S7C54 - Cardiogenic shock Flashcards
1
Q
Defn
A
-state of decreased CO resulting in inadequate tissue perfusion despite adequate blood volume
2
Q
Mortality rate in cardiogenic shock:
A
50%
3
Q
Causes of cardiogenic shock
A
Acute MI
- pump failure
- mechanical complications (MR from pap. msc rupture, VSD, free-wall rupture)
RV infarct
Depression of cardiac contractility
- sepsis
- myocarditis
- myocardial contusion
- cardiomyopathy
Obstruction to forward flow:
- Ao/mitral stenosis, HOCM, myxoma
- pericardial tamponade
Acute aortic insufficiency
4
Q
Hemodynamic criteria for cardiogenic shock
A
- sustained HoTN
- reduced cardiac index
- elevated pulmonary artery occlussion pressure
5
Q
DDx Cardiogenic shock
A
- MI
- PE
- COPD exac
- pericarditis
- myocarditis
- aortic dissection
- pericardial tamponade
- acute valvular insufficiency
- sepsis
- hemorrhage
- toxins/drugs
6
Q
Cardiogenic shock tx: Airway
A
- ETT usually necessary as pts not conscious enough to tolerate bipap
- be ware that positive pressure may further decrease preload and CO and therefore worsen HoTN
- may need to give a fluid bolus if no pulmonary congestion present, or vasopressors or inotropes
7
Q
Cardio. shock tx: Stabilization
A
- hypoxia
- hypovolemia
- rhythm disturbance
- electrolyte abn.
- acid-base alterations
- place arterial line
- place a foley
- do not give BB for pts in cardiogenic shock, ACEi should also be held until pt is stable as it can cause further renal damage acutely
8
Q
Cardio. shock tx: Hypotension
A
- try a small fluid challenge (100-250cc)
- if pulmonary congestion, do not give crystalloids
- if HoTN plus pulm congestion, give vasopressors or inotropes
- combo of dopamine (vasopressor) and dobutamine (inotrope)
- don’t give pure alpha-1 agonists (phenylephrine) b/c they increase cardiac afterload w/o augmenting cardiac contractility
- if BP
9
Q
Cardio. shock and acute MR:
A
-consider dobutamine and nitroprusside for contractility and afterload reduction
