Cardiogenic shock occurs when the heart is unable to pump sufficiently due to issues like a myocardial infarction. It leads to low blood flow and organ dysfunction. Symptoms include chest pain, breathing issues, and hypotension. Treatment focuses on optimizing oxygen delivery through ventilation, volume resuscitation, inotropes, and procedures like IABP or surgery if needed. Nursing care monitors for worsening and supports the patient through the condition.

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.