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1. CARDIOGENIC
SHOCK
RATHEESH R.L

2. INTRODUCTION
 Shock is a failure of the circulatory system to
maintain adequate perfusion of vital organs.

3. TYPES OF SHOCK
Neurogenic shock
Septic shock
Anaphylactic shock
 Hypovolemic Shock
 Cardiogenic Shock

4. CARDIOGENIC SHOCK
 Cardiogenic shock occurs when the
heart is unable to function adequately
resulting in insufficient blood flow to
tissue and organs.

5. ETIOLOGY
• Acute Myocardial Infarction
• Sepsis
• Myocarditis
• Endocarditis
• Myocardial contusion
• Aortic or mitral stenosis
• Acute aortic insufficiency
• Cardiac rupture
• Peripheral vascular disease

6.  Cerebrovascular diseases
 Hypertrophic cardiomyopathy
 Acute mitral regurgitation
 Endocarditis
 Post cardiac surgery
 Pneumothorax
 Suppression of myocardial contractility(beta
blockers)

7. PATHOPHYSIOLOGY

8. CLINICAL FEATURES
 Chest Pain
 Nausea And Vomiting
 Dyspnea
 Cyanosis
 Excessive Sweating
 Confusion
 Restlessness
 Mental Lethargy
 Palpitation
 Syncope
 Cold, Clammy Skin

9.  Slow Capillary Refill
 Weak Thready Peripheral Pulses
 Hypotension
 Bradycardia/Tachycardia
 Distention Of Neck Veins
 Peripheral Edema
 Murmer
 Pulmonary Crackles/Wheeze
 Oliguria
 Altered Mental Status

10. DIAGNOSIS
History Collection
• Recent illness
• Fever
• Chest pain, SOB
• Abdominal pain
• Comorbidities
• Medications
• Toxins/Ingestions
• Recent hospitalization or surgery
• Baseline mental status

11.  Physical examination
• Vital Signs
• CNS – mental status
• Skin – color, temp, rashes, sores
• CV – JVD, heart sounds
• Respiratory – lung sounds, RR, oxygen sat, ABG
• GI – abd pain, rigidity, guarding, rebound
• Renal – urine output

12.  ECG
 ECHOCARDIOGRAPHY
 CORONORY ANGIOGRAM
 LABORATORY STUDIES
 Complete blood count
 Arterial blood gas monitoring
 Cardiac enzyme tests

13. GOALS OF TREATMENT
• ABCD
• Airway
• control work of Breathing
• optimize Circulation
• assure adequate oxygen Delivery

14. AIRWAY
• Determine need for intubation but
remember: intubation can worsen
hypotension
• Sedatives can lower blood pressure
• Positive pressure ventilation decreases preload
• May need volume resuscitation prior to
intubation to avoid hemodynamic collapse

15. CONTROL WORK OF BREATHING
• Respiratory muscles consume a significant
amount of oxygen
• Mechanical ventilation and sedation decrease
WOB and improves survival

16. OPTIMIZING CIRCULATION
• Isotonic crystalloids
• maintain:
• CVP 8-12 mm Hg
• Urine output 0.5 ml/kg/hr (30 ml/hr)
• Improving heart rate
• May require 4-6 L of fluids
• No outcome benefit from colloids

17. MAINTAINING OXYGEN DELIVERY
• Decrease oxygen demands
• Provide analgesia and anxiolytics to relax muscles and
avoid shivering
• Maintain arterial oxygen saturation/content
• Give supplemental oxygen
• Maintain Hemoglobin > 10 g/dL
• central venous oxygen saturations to assess
tissue oxygen extraction

18. THEN……
* Positioning
 the recommended position for the patient in
shock is supine with legs elevated 45 degrees.

19. MANAGEMENT OF SHOCK
 Vasoconstrictors
 Dopamine
 Norepinephrine
 Vasodilators
 Nitroprusside
 Nitroglycerin
 Sympathomimetics
 Epinephrine
 Corticosteriods
 Hydrocortisone sodium
 Appropriate antidotes
or antibiotics
* Pharmacologic Management

20. OTHER METHODS
 INTRA AORTIC BALLOON PUMP
This device is placed in the aorta, the main
blood vessel that carries blood from the heart
to body.
This balloon is inflated and deflated in a rhythm
that exactly matches the rhythm of heart.
This helps the weakened heart muscle to pump
as much as blood to other organs of the body.

21.  Angioplasty and stent
 Angioplasty is a procedure used to open
narrowed or blocked coronary arteries.
 A stent is a small tube that placed in
coronary artery during angioplasty to keep
the artery open.

22. SURGERY
 Coronary artery bypass graft
 Surgery to repair an injured heart
 Heart transplantation

23. NURSING MANAGEMENT
 Identify patients at risk for development of
cardiogenic shock
 Assess the early signs and symptoms of
cardiogenic shock
 Assess the mental status of the patient
 Monitor vital signs frequently
 Check the peripheral pulses
 Observe for edema in the lower extrimities

24.  Maintain an intake-output chart
 Observe the signs of peripheral cyanosis
 Assess the heart and lung sounds
 Monitor for chest pain and diaphoresis
 Provide psychological support to the patient and
relatives.

25. NURSING DIAGNOSIS
 Decreased cardiac output related to impaired cardiac
contractility as evidenced by hypotension.
 Impaired gas exchange related to pulmonary congestion
as evidenced by decreased oxygen saturation levels
 Impaired tissue perfusion related to decreased cardiac
contractility and blood flow as evidenced by increased
capillary refilling time >3 seconds

26.  Fear and anxiety related to intensive care
environment as evidenced by fearful facial
expression
 Activity intolerance related to decreased
cardiac activity and laboured respirations as
evidenced by difficulty in performing activities
of daily living

27.  Imbalanced nutrition less than body requirement
related to breathlessness as evidenced by
weight loss
 Disturbed sleep pattern related to shortness of
breath as evidenced by presence of dark circles
around the eyes.