Cardiogenic shock is a condition resulting from the heart's inability to pump blood efficiently, often caused by severe heart attacks and associated with high mortality rates. Key factors include pre-existing heart conditions, hypertension, diabetes, and obesity, with clinical manifestations such as chest pain, diminished heart sounds, and low blood pressure. Management involves correcting underlying causes, pharmacological treatments, surgical options, and nursing care focused on monitoring and prevention strategies.

1. CARDIOGENIC
SHOCK
-RAKSHA YADAV
B.Sc Nursing 2nd Year
AIIMS, JODHPUR

2. Cardiogenic shock
 Definition
 Predisposing/Risk factors
 Etiological factors
 Pathophysiology
 Clinical Manifestations
 Complications
 Diagnostic tests
 Medical Management
-Pharmacological Management
-Surgical Management
 Nursing Management
 Prevention of cardiogenic shock

3. Definition
 What is Cardiogenic shock?
Cardiogenic shock is defined as heart’s
inability to contract and pump blood
efficiently due to inadequate supply of O2 &
nutrients to the heart.
 Most often caused by severe heart attack.
 Mortality rate is very high (50-75%), if not
treated immediately

4. Predisposing/Risk Factors
 Older age
 A history of heart attacks or heart failure
 Coronary heart disease (CHD)- Affects all the
major blood vessels of heart
 Hypertension
 Diabetes
 Obesity
 Atherosclerosis

5. Etiological Factors
• Acute MI
• Severe hypoxemia
• Cardiomyopathy
• Pericardial tamponade
• Acidosis
• Dysrhythmias
• Trauma
• Structural abnormalities
• Valvular abnormality
• Ventricular septal rupture
• Tension pneumothorax

6. Pathophysiology
↓ Cardiac
Contractibility
↓ Stroke
Volume &
C.O
Pulmonary
Congestion
↓Systemic
Tissue
Perfusion
↓ Coronary
Artery
Perfusion

7. Clinical Manifestations
 Angina Pectoris, squeezing pain in center of chest.
 Dysrhythmias
 Diminished heart sounds
 Acute drop in blood pressure > 30 mm Hg
 Decreased cardiac output
 Tachypneas, shortness of breath
 Weak, thready pulse
 Sweating, cold hand & feet
 Urine output < 30 mL/hr
 Cool, pale, moist skin

8. Complications
 Brain damage
 Kidney damage
 Liver damage
 Multiple organ failure
 Coma
 Death

9. How is Cardiogenic shock
diagnosed?
 Blood pressure test
 Electrocardiogram
 Echocardiography
 Chest X-ray
 Cardiac enzyme test
 Coronary angiography
 Pulmonary artery catheterization
 Blood tests:
- ABG, LFT, RFT

10. Medical Management

11.  Correction of underlying cause:
→ Correction of the underlying cause is very
important as it may lead to:
- Fail of the compensatory mechanisms
- It can reduce the effectiveness of the
interventions
→ Correction of:
- Dysrhythmia
- Acidosis & electrolyte disturbances

12.  Initiation of first line treatment:
→ Oxygenation- Nasal cannula @ 2-6 lpm
→ Hemodynamic Monitoring- BP
→ Fluid Therapy- RL, NS, Dextran
→ Pain Control- Morphine

13.  Pharmacological Management:
→ Dobutamine
→ Nitroglycerine (Vasodilator)
→ Dopamine
→ Vasoactive Medications
> Epinephrine
> Nor- Epinephrine
> Vasopressin (ADH)

14.  Surgical Management:
→ CABG (Coronary artery bypass graft)
→ Replacement of Faulty Cardiac valve

15. Nursing Management : Our main
Focus

16. Monitoring Hemodynamic Status:
 Assess vitals regularly.
 Maintain a patent arterial line, if any
 Assess functioning of ECG monitor &
readings

17. Administering medications & IV fluids:
 Monitor vitals before and after administering
medications & IV fluids.
 Administer prescribed medications & fluids
accurately (Follow10 Rights)
 Assess IV infusion site for bleeding or any
allergic response.
 Monitor:
- Urine Output
- BUN Indicators of renal function
- Serum Creatinine

18.  Preventing Complications:
 Notify the physician promptly if:
- Hemodynamic, Cardiac or Pulmonary status
changes.
- Decline in ABG or Pulse Oximeter values
- Adventitious breath sounds heard
- Changes in cardiac rhythm

19. Limit myocardial oxygen demand by:
 Administering analgesics, sedatives, and other agents
as prescribed.
 Positioning the patient for comfort.
 Limiting activities.
 Providing calm and quiet environment
 Offering support to reduce anxiety.
 Teaching the patient about his condition.
Enhancing myocardial oxygen supply by:
 Administering oxygen.
 Monitoring the patient’s respiratory status.
 Administering prescribed medications.

20. How can Cardiogenic shock be
prevented?
 Adopt ‘Heart healthy lifestyle’
 Take healthy diet
- Low in sodium & fat
 Control hypertension and diabetes
 Reduce obesity- Be physically active
 Quit smoking
 If lifestyle changes are not enough, Take all of
your medicines as prescribed.