Cardiogenic shock is defined as persistent hypotension and hypoperfusion due to cardiac dysfunction with adequate filling pressures. It is commonly caused by left ventricular failure due to an extensive acute myocardial infarction. Signs include low blood pressure, decreased cardiac output, and signs of hypoperfusion. Treatment involves optimizing preload, inotropic support, vasopressor therapy, and mechanical circulatory support such as IABP or VAD if refractory to medical management.
Cardiogenic shock is a rare condition .in this heart unable to pump an adequate amount of blood flow. types coronary cardiogenic shock and noncoronary cardiogenic shock.causes include any rupture of the in the ventricles .mi condition, any infectious condition,any medication that is a rare condition of the heart Are older
Have a history of heart failure or heart attack
Have blockages (coronary artery disease) in several of your heart's main arteries
Have diabetes or high blood pressure
Are female, Race or ethnicity
Cardiogenic shock signs and symptoms include:
Rapid breathing
Severe shortness of breath
Sudden, rapid heartbeat (tachycardia)
Loss of consciousness
Weak pulse
Low blood pressure (hypotension)
Sweating
Pale skin
Cold hands or feet
Urinating less than normal or not at all
treatment like emergency medication,dopamine ,doputamine ,adrenaline also given as a treatment to the patent. some other surgical procedure is there like cabg , heart transplantationmetc. preventionj oxf this avoid smoking,control alcohol,avoid stress etc
-
Cardiogenic shock is a rare condition .in this heart unable to pump an adequate amount of blood flow. types coronary cardiogenic shock and noncoronary cardiogenic shock.causes include any rupture of the in the ventricles .mi condition, any infectious condition,any medication that is a rare condition of the heart Are older
Have a history of heart failure or heart attack
Have blockages (coronary artery disease) in several of your heart's main arteries
Have diabetes or high blood pressure
Are female, Race or ethnicity
Cardiogenic shock signs and symptoms include:
Rapid breathing
Severe shortness of breath
Sudden, rapid heartbeat (tachycardia)
Loss of consciousness
Weak pulse
Low blood pressure (hypotension)
Sweating
Pale skin
Cold hands or feet
Urinating less than normal or not at all
treatment like emergency medication,dopamine ,doputamine ,adrenaline also given as a treatment to the patent. some other surgical procedure is there like cabg , heart transplantationmetc. preventionj oxf this avoid smoking,control alcohol,avoid stress etc
-
Definition of arrhythmia - background on cardiac physiology including conduction in heart - action potential - pathogensis of arrhythmia - causes and risk factors for arrhythmia- diagnosis of arrhythmia - symptoms of tachyarrhythmias and bradyarrhythmias - investigations for arrhythmia - treatment of arrhythmia - pharmacological and other modalities of therapy for arrhythmia - managment of different types of arrhythmias
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
a clinical syndrome that results from inadequate tissue perfusion.
Hypovolemic shock - Blood or fluid loss, both leading to a decreased circulating blood volume, diastolic filling pressure, and volume.
Cardiogenic shock - due to cardiac pump failure related to loss of myocardial contractility/functional myocardium or structural/mechanical failure of the cardiac anatomy and characterized by elevations of diastolic filling pressures and volumes
Extra-cardiac/obstructive shock - due to obstruction to flow in the cardiovascular circuit and characterized by either impairment of diastolic filling or excessive afterload
Distributive shock - caused by loss of vasomotor control resulting in arteriolar/venular dilatation leading to a decrease in preload, with decreased, normal, or elevated cardiac output, depending on the presence of myocardial depression.
Definition of arrhythmia - background on cardiac physiology including conduction in heart - action potential - pathogensis of arrhythmia - causes and risk factors for arrhythmia- diagnosis of arrhythmia - symptoms of tachyarrhythmias and bradyarrhythmias - investigations for arrhythmia - treatment of arrhythmia - pharmacological and other modalities of therapy for arrhythmia - managment of different types of arrhythmias
The term inotropic state is most commonly used in reference to various drugs that affect the strength of contraction of heart muscle (myocardial contractility). However, it can also refer to pathological conditions. For example, enlarged heart muscle (ventricular hypertrophy) can increase inotropic state, whereas dead heart muscle (myocardial infarction) can decrease it.
a clinical syndrome that results from inadequate tissue perfusion.
Hypovolemic shock - Blood or fluid loss, both leading to a decreased circulating blood volume, diastolic filling pressure, and volume.
Cardiogenic shock - due to cardiac pump failure related to loss of myocardial contractility/functional myocardium or structural/mechanical failure of the cardiac anatomy and characterized by elevations of diastolic filling pressures and volumes
Extra-cardiac/obstructive shock - due to obstruction to flow in the cardiovascular circuit and characterized by either impairment of diastolic filling or excessive afterload
Distributive shock - caused by loss of vasomotor control resulting in arteriolar/venular dilatation leading to a decrease in preload, with decreased, normal, or elevated cardiac output, depending on the presence of myocardial depression.
Cardiogenic shock : Medical Surgical NursingRaksha Yadav
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.
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2. *
*Cardiogenic shock (CS) is defined as persistent
hypotension and tissue hypoperfusion due to cardiac
dysfunction in the presence of adequate
intravascular volume and left ventricular filling
pressure.
*Hemodynamically : persistent hypotension (systolic
blood pressure <80 to 90 mm Hg or mean arterial
pressure 30 mm Hg lower than baseline) with severe
reduction in cardiac index (<1.8 L · min−1 ·
m−2 without support or <2.0 to 2.2 L · min−1 ·
m−2 with support) and adequate or elevated filling
pressure (eg, left ventricular [LV] end-diastolic
pressure >18 mm Hg or right ventricular [RV] end-
diastolic pressure >10 to 15 mm Hg
3. *
*COMMON- left ventricular failure due to extensive
acute myocardial infarction
*ACCORDING TO SHOCK TRIAL REGISTRY
7. *Evidence of hypoperfusion (low cardiac output)
manifested by
sinus tachycardia,
low urine output, and cool extremities
patients who develop acute MI present with
an abrupt onset of squeezing or heavy substernal chest
pain; the pain may radiate to the left arm or the neck.
The chest pain may be atypical, the location be in
epigastric or only in the neck or arm.
The pain quality may be burning, sharp, or stabbing.
8. *
*history of previous cardiac disease,
*use of cocaine,
*previous myocardial infarction (MI), or previous
cardiac surgery
* A patient thought to have MI should be assessed for
cardiac risk factors.
*associated symptoms are
* diaphoresis,
*exertional dyspnea,
*Presyncope or syncope,
*palpitations, generalized anxiety, and are other
features indicative of poor cardiac function.
9. *
*ashen or cyanotic ,cool skin and mottled extremities
*Peripheral pulses are rapid and faint and irregular if
arrhythmias are present
*Jugular venous distention and crackles
*peripheral edema also may be present.
*third and fourth heart sounds may be present
*The pulse pressure may be low, and patients are usually
tachycardic
*signs of hypoperfusion, such as altered mental status and
decreased urine output
*systolic murmer
*paradoxical thrill
10. *
Laboratory Studies
* RFT, LFT, serum electrolytes to assess the functiong of vital
organs
*(CBC) is helpful to exclude anemia
Cardiac enzymes to diagnose MI
creatine kinase- elevate within 10hrs, peaks at 24-48
hours
troponin-Troponin levels peak at 14 hours after acute MI
myoglobin- 4-fold rise of myoglobin over 2 hours
LDH
ABG
11. LDH- Elevated lactate values in a patient with signs of
hypoperfusion
BNP- indicator for heart failure
IMAGING STUDIES
echocardiography
helps to deteremine mechanical causes of shock, such as
acute ventricular septal defect, free myocardial wall rupture,
pericardial tamponade, and papillary muscle rupture causing
acute mitral regurgitation
*Assess the valvular and left ventricle function
12. *
*HELP TO exclude other causes of chest pain tension
pneumothorax ,pneumomediastinum etc
Manifest signs of LVF
*pulmonary vascular redistribution,
*interstitial pulmonary edema,
*enlarged hilar shadows
*the presence of Kerley B lines,
*cardiomegaly, and bilateral pleural effusions.
13. Ultrasonography
Ultrasonography can be used to guide fluid management
Coronary artery angiography
Assess the anatomy of the coronary arteries and need for
revascularisation
ECG
Assesss ST-segment elevation, ST-segment depression, or Q
waves. T-wave inversion
14. *Help to precise measurement of volume status,
left and right ventricular filling pressures, and
cardiac output
* Help guide fluid management and the use of
inotropic agents and vasopressors
*Hemodynamic measurements can help guide
fluid management and the use of inotropic
agents and vasopressors
15. *
*class I - patients with hypotension not responding to fluid
administration or when mechanical complications of
myocardial infarction are suspected and echocardiography is
not available.
*class II recommendation for patients in CS who have
persistent signs of hypoperfusion and in patients receiving
inotropic and vasopressor drugs.
(PCWP) of greater than 15 mm Hg and a cardiac index of less
than 2.2 L/min/m2
18. Inotropic Agents
augments the coronary blood flow
Dopamine
Dopamine stimulates adrenergic and dopaminergic receptors
Action depend upon the dose
*(low dose): 1-5 mcg/kg/min IV- increase urine output and
renal blood flow
*(medium dose): 5-15 mcg/kg/min IV ; increase renal blood
flow, cardiac output, heart rate, and cardiac contractitlity
*(high dose): 20-50 mcg/kg/min IV ; increase blood pressure
and stimulate vasoconstriction; may not have a beneficial
effect in blood pressure; may increase risk of
tachyarrhythmias
19. Dobutamine
*a sympathomimetic amine with stronger beta effects than
alpha effects
*produces systemic vasodilation and increases the inotropic
state
*DOSAGE; 2-20 mcg/kg/min IV or IO
*not to exceed 40 mcg/kg/min
*Higher doses may cause an increase in heart rate,
exacerbating myocardial ischemia
20. *Norepinephrine
(Levophed)
*is a naturally occurring catecholamine with potent alpha-
receptor and mild beta-receptor activity
*It stimulates beta1- and alpha-adrenergic receptors,
resulting in increased cardiac muscle contractility, heart
rate, and vasoconstriction
*There by increase bp and afterload
*Increased afterload may result in decreased cardiac output,
increased myocardial oxygen demand, and cardiac ischemia
*DOSAGE
Initial: 8-12 mcg/min IV infusion; titrate to effect
Maintenance: 2-4 mcg/min IV infusion
21. *Milrinone
*It is a selective phosphodiesterase inhibitor in cardiac and
vascular tissue with positive inotropic and vasodilator
effects; it has little chronotropic activity
*DOSAGE
50 mcg/kg loading dose by IV push over 10 minutes, then
0.375-0.75 mcg/kg/min IV
Maintenance: 1.13 mg/kg/day
22. *Inamrinone
*Formerly known as amrinone, inamrinone is a
phosphodiesterase inhibitor with positive inotropic and
vasodilator activity
*DOSAGE
*Load: 0.75 mg/kg IV bolus over 2-3 minutes, THEN
*5-10 mcg/kg/min IV
*should not exceed 10 mg/kg/day
*likely to cause tachycardia than is dobutamine, and it may
exacerbate myocardial ischemia
23.
24. *
*Vasodilators decrease preload and/or afterload.
Nitroglycerin IV
causes relaxation of vascular smooth muscle by stimulating
intracellular cyclic guanosine monophosphate production
*intolerant of or unresponsive to SL NTG 5 mcg/min
*Increase by 5 mcg/min q3-5min up to 20 mcg/min, THEN
Increase by 10 mcg/min
25. *
*to decrease plasma volume and edema and thereby
decrease cardiac output and, consequently, blood pressure
*Furosemide (Lasix)
inhibits sodium and chloride reabsorption in the ascending
loop of Henle and the distal renal tubule.
DOSAGE; Alternative: 20-40 mg IV/IM once
36. * many patients develop CS IN HSPITAL results from
infarction extension, reocclusion of a previously patent
coronary artery, recurrent ischemia, or decompensation
of left ventricular function in the noninfarcted zone
because of metabolic derangements
*FIBRINOLYTIC therapy as not much effective as primary
coronary intervention
37. *
*Used for patients with CS refractory to IABP
and reperfusion strategies
* very low cardiac output, less than 1.2
L/min/m2
38. *
Mechanical circulatory device that is used to
replace the pumping action of a failing
human heart.
Left ventricular failure is primarily treated
using a VAD.
39.
40. *Almost all VADs are made up of 3 parts:
*A pump that is implanted inside the body
(an implantable VAD) or that is placed
outside the body (an external
or paracorporeal VAD)
*A system controller that stays outside the
body and is used to program the settings of
the VAD
*An outside energy source to power the
pump—either a console or a battery pack.