cardiogenic shock

• pathophysiology

  • Heart cannot contract good
  • Impaired perfusion
  • inadequate pumping ability of heart muscle
  • decreased contractility
• Causes of cardiogenic shock

  • Massive MI
  • Blunt cardiac injury (Mvc)
  • Cardiomyopathy
  • Severe Heart failure
• Clinical Manifestations

  • Hypotension
  • Chest pain
  • Tachypnea
  • Oliguria
  • Change in LOC
  • decreased CO
  • increased troponin
  • pulmonary edema
  • metabolic acidosis
• Mechanical device support

  Balloon pump, LVAD
• teach

  • stop smoking
  • cardiac diet.
  • careful with exertion
• mgmt

  • assess
  • HD monitoring
  • prepare for intubation
  • Oxygenation
  • labs
  • admin meds as ordered
  • admin fluids
  • IABP care
  • restrict activity
• Meds

  • Vasopressors (to maintain MAP BP)
  • Inotropes to improve CO
  • Nitroglycerin (for chest pain)
  • Diuretics - careful w/ too much fluid loss, will decrease circulation, CO and tissue perfusion
• Vasopressors: norepinephrine, dopamine, vasopressin, phenylephrine
• Inotropes: dobutamine, epinephrine
• Diuretics can mask symptoms of MI
• Need arterial line
• Diagnostics

  • ECG-rule out MI
  • Labs- cardiac enzymes, ABG, CMP, lactate
  • Chest X-ray-size of heart & fluid buildup
• Management

  Stabilize oxygen and start meds to increase CO and BP

  100% NRB, vent

  Mechanical device support: Balloon pump, LVAD

  PCI

  ecmo