1. Cardiogenic Shock
M.H.C Peiris BSc, RN,RM
Dip in Teaching and Supervision
Special Grade Nursing Tutor
Post Basic College of Nursing
Colombo

2. • Shock is a systemic clinical syndrome that can be
said to exist when perfusion is insufficient to
meet the metabolic demands of body tissues.
• If left uncorrected it will lead to irreversible cell
damage and multiple organ failure and death.
• It can occur because of one significant or
multiple smaller infarcts in which over 40% of the
myocardium becomes necrotic , a ruptured
ventricle, significant valvular dysfunction or at
the end stage of heart failure.

3. • It can also result from cardiac
tamponade,cardiomyopathy, pulmonary
embolism or dysrhythmias.

4. Assessment
• Required argent attention
–Acute dyspnea
–Profound hypotension
–Pale/ cyanotic
–Cold/clammy
–arrhythmias

5. • Blood pressure; severe hypotension, due
to radically reduced cardiac output.
• Pulse; tachycardia; the heart rate increases to
compensate for the reduced cardiac output .
But in profound stages the rate may become
weaker and arrhythmias may occur

6. • Respiration; oxygen therapy is vital if
hypoxia is to be restricted. An upright position
will help to reduce venous return
• Again in extreme cases intubation and
ventilation may be required. Arterial blood
gases must be performed on regular basis to
monitor levels of the hypoxemia and any rise
in the carbon dioxide levels

7. Priorities for care
• Ideally the patients should be cared for in the
resuscitation environment with;
• Cardiac monitoring
• i.v access and CVP access
• oxygen therapy
• baseline observations
• catheterization

8. Clinical investigations
• Renal care- urine measurement is vital to
measure the effectiveness of drug therapy and
Urea & Electrolytes to monitor potassium levels.
• Blood analysis -FBC and cardiac enzymes
cardiac troponins.
• ECG- may show multifocal ventricular ectopic
indicative of an irritable ventricle, or
systemic changes suggestive of an acute MI
• Chest X-ray-evidence of pulmonary edema
and cardiac enlargement.

9. Management
• Frequent observation and cardiac monitoring to detect
life threatening
• Aggressive i.v diuretics therapy
• Vasodilatations ( iv nitrates)
• inrtopic agents( dobutamine, dopamine or adrenaline
• Rapid administration of alteplase to dissolve thrombi
• On occasion an intra aortic balloon pump
• Thought and consideration must be given to the family
and friends