This presentation is designed for Nursing students and it gives a brief about what you should know while caring for a client with Cardiogenic shock and also its prevention.

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.