1. Cardiogenic shock occurs when the heart is damaged and unable to pump enough blood to vital organs, which can lead to organ failure. 2. It is caused by conditions like heart attack that damage the heart muscle and impair its ability to contract and pump effectively. 3. Symptoms include low blood pressure, confusion, and reduced urine output as the kidneys are not adequately perfused. Treatment focuses on supporting blood pressure and cardiac function through medications, and procedures like coronary interventions can also be used.

1. CARDIOGENIC SHOCK
Mrs. Jyoti Srivastava

2. Cardiogenic shock occurs when the heart has
been damaged so much, that it is unable to
supply enough blood to the vital organs of the
body. As a result of the failure of the heart to
pump enough nutrients to the body, blood
pressure falls and organs may begin to fail.
Cardiogenic shock is uncommon, but when it
does occur, it’s a serious medical emergency.
INTRODUCTION

3. Cardiogenic shock is the failure of heart to
pump blood adequately to meet the
oxygenation needs of body.
( Cardiovascular Medicine)
Cardiogenic Shock is defined as the hearts
inability to contract and pump the blood
effectively due to inadequate supply of
oxygen and nutrients to the body.
(Red cross Society)
DEFINITION

4.  Incidence rate of cardiogenic shock is 43.7%.
 40 to 70 % cardiogenic shock is with Acute MI
INCIDENCE

5. Acute MI
Severe Hypoxia
Cardiomyopathy
Pericardial tamponade
Acidosis
Dysrhythmia
Trauma
Structural Abnormalities.
ETIOLOGY

6. Classification based on .
 Coronary cardiogenic shock
 Non coronary Cardiogenic shock
CORONARY CARDIOGENIC SHOCK
Coronary cardiogenic shock occurs when the significant
amount of the left ventricular myocardium has been
damaged.
Eg Myocardial infraction.
More common
.

7.  NON CORONARY CARDIOGENIC SHOCK
 Occur mainly due to stress to myocardium.
Examples severe hypoxemia
 Acidosis
 Hypoglycaemia
Tension pneumothorax
.

8. Older age
History of heart disease
Hypertension
Diabetes mellitus
Obesity
Atherosclerosis
RISK FACTORS

9. PATHOPHYSIOLOGY
Structural problem Dysrhythmias
Systolic Dysfunction : Ineffective Forward
movement of blood
Stroke
volume
Diastolic
dysfunction:
Ineffective Filling
Primary
ventricular
ischemia

10. .
Cardiac
output
(amount of
blood the heart
pump from
each ventricle
per minute )
Pulse pressure
Pulmonary
edema
Oxygenation
Cellular oxygen
Tissue perfusion
Impaired Cellular Metabolism

11. 1. The classic signs and symptoms of cardiogenic shock
are the heart muscle loses it’s contractle power,
resulting in a marked reduction of SV and CO.
2. Confusion, restlessness, mental lethargy ( due to
poor perfusion of brain)
3. Low Systolic Blood pressure
4. Oliguria ( urine output less than 30ml/hr( due to
decrease perfusion of kidneys)
5. Chest pain( due to lack of oxygen and blood to
heart muscle).
CLINICAL FEATURES

12. Cold ,clammy skin.
Thready peripheral pulses .
Distended neck vein.
Tachypnea, with respiratory crackles.
 cyanosis.
sweating, cold hand and feet
.

13. History Collection
Physical Examination ( Hypotension, Tachycardia,
cyanosis, S3 Gallop sound)
 ECG ( ST Segment elevation)
 Echocardiogram
Chest x-ray ( reveal pulmonary congestion)
Cardiac enzyme test ( CPK-MB,)
 Coronary angiography
 Pulmonary artery catheterization
 ABG, LFT & Renal function test
DIAGNOSTIC MEASURES

14.  Management measures include
MANAGEMENT
1. MEDICAL MANAGEMENT
2. SURGICAL MANAGEMENT
3. NURSING MANAGEMENT

15. MEDICAL MANAGEMENT

16. The goal of medical management in cardiogenic shock
are.
1. To limit further myocardial damage and preserve the
healthy myocardium. ( To improve blood f low to
myocardium)
2. To improve the cardiac function by increasing cardiac
contractility, decreasing ventricular after load or both.
In general this goals are achieved by increasing oxygen
supply to the heart muscle while reducing oxygen
demands.
GOAL

17. First line treatment of cardiogenic shock involves the
following actions.
1. Supplying supplemental oxygen
2. Controlling chest pain
3. Providing selected fluid support
4. Administrating vasoactive medications
First-line treatment

18.  Oxygen therapy
Oxygen is administrated at a rate 2 to 6 L/Min to
achieve oxygen saturation above 90 %.
Monitoring of ABG Value and pulse oximetry help
to determine if patient require more oxygen
therapy.
Pain Control
Morphine sulphate ( IV)

19.  Drug therapy
Vasopressors
Maintain mean arterial pressure
Eg Dopamine , Norepinephrine
 Inotropic Agents
Increase myocardial contractility
Eg Milrinone, Levosimendan, dobutamine
 Vasodilator
Relax vascular smooth muscles, reduce systemic
vascular resistance and cardiac output.
Eg Nitro-glycerine, Sodium Nitro prusside

20. Diuretics
Furosemide
 Other medications include antiarrhythmic medications
and fluid therapy.

21. SURGICAL MANAGEMENT

22. Percutaneous coronary intervention
Coronary Artery bypass graft
Intra – aortic Balloon Pump ( IABP)
Transvenous pacing
Percutaneous Ventricular Assist Device.
Extracorporeal Membrane oxygenation
Left ventricular assist Device.
SURGICAL PROCEDURES

23.  coronary artery bypass graft (CABG) surgeries are
among the most commonly performed major
operations.
 CABG surgery is advised for selected groups of patients
with significant narrowing and blockages of the heart
arteries (coronary artery disease , cardiogenic shock).
 CABG surgery creates new routes around narrowed and
blocked arteries, allowing sufficient blood flow to
deliver oxygen and nutrients to the heart
muscle.(saphenous vein, mammary or radial artery)
CORONARY ARTERY BYPASS GRAFT

24.  PCI is recommended for client with acute MI
followed by cardiogenic shock.
 Percutaneous coronary intervention is performed by
inserting a catheter through the skin in the groin or
arm into an artery.
 At the leading tip of this catheter, several different
devices such as a balloon, stent, or cutting device
(artherectomy device) can be deployed.
 The catheter and its devices are threaded through
the inside of the artery back into an area of coronary
artery narrowing or blockage.
PERCUTANEOUS CORONARY
INTERVENTION ( PCI)

25.  IABP Is a device used for mechanical circulatory
assistance in case of LV dysfunction on the principle
of counter pulsation
1. The goals of IABP include the following..
2. Increased SV
3. Improved coronary artery perfusion Decreased
preload
4. Decreased cardiac work load
INTRAAROTIC BALLON PUMP

26.  IABP Consist of intra aortic balloon about 1o inches
long placed over the distal end of catheter.
 Catheter is inserted surgically or percutaneously over
femoral artery.
 When it reaches in aorta ,tip of balloon is positioned
just below the tip of the origin of left subclavian
artery.
PROCEDURE

27.  Pump console monitor the patient’s heartbeat
 R Wave in the ECG trigger pumps inflating mechanism
 As balloon inflates it displaces the blood, increase
aortic pressure, which increase coronary blood flow.
 During left ventricular ejection balloon deflates, thus
reducing aortic pressure, help in ejection of blood
from left ventricle, reducing workload of left
ventricle.
.

28. IABP

29.  when IABP become insufficient percutaneous
ventricular assist device is used.
 Shock persist after coronary revascularization.
 Eg TANDEM HEART DEVICE,
IMPELLA
PERCUTANEOUS VENTRICULAR
ASSIST DEVICE

30.  Provides hemodynamic support and
oxygenation if lung function is
compromised.
EXTRACORPOREAL MEMBRANE
LEFT VENTRICULAR ASSIST DEVICE
Used in patients with acute
myocardial infraction complicated
by cardiogenic shock

31. NURSING MANAGEMENT

32. NURSING ASSESSMENT.
Administer safe and accurate IV fluids and
medications. Documents and records medications
and treatment that are administered as well as the
patient response to treatment.
Patients receiving thrombolytic therapy must be
monitored for bleeding. Arterial and venous
puncture sites must be observed for bleeding, and
pressure must be applied at the sites if bleeding
occurs.
.
Nursing management

33. Neurologic assessment is essential after the
administration of thrombolytic therapy to assess for
the potential complications of cerebral haemorrhage
associated with the therapy.
Urine output ,BUN ,creatinine levels should be
monitored.
Maintain mechanical assistive devices function
Prevent complications associated with cardiogenic
shock. Enhancing safety and comfort.
.

34.  Decreased cardiac output related to impaired
contractility due to extensive heart muscle damage.
GOAL
Improving cardiac output
INTERENTION
Establish continuous ECG monitoring
 Hemodynamic monitoring
Closely monitor adverse response to drug therapy
 Monitor BP with intra-arterial line continuously.
Measure and record intake and urine out put
NURSING DIAGNOSIS

35.  GOAL :Improving oxygenation
 INTERVENTION
1. Monitor rate and rhythm of respiratory every hour.
* Auscultation lung fields for abnormal sounds *
ABG evaluation *
2. Administer oxygen * Invasive oxygen therapies
(ET & MV)
 Impaired gas exchange related to
pulmonary congestion due to elevated left
ventricular pressure

36.  Ineffective tissue perfusion ( renal,
cerebral, cardiopulmonary GI and
peripheral) related to decreased blood
flow
 GOAL : Maintaining adequate Tissue
perfusion INTERVENTION
 Perform neurologic assessment every hour using
with “Glasgow coma scale” ( GCS)
 Report changes immediately
 Obtain BUN & creatinine blood levels & monitor
output to evaluate renal function.

37. Goal : To Relive anxiety
 Assess the anxiety level
 Provide adequate information regarding physical
condition
 Encourage to ask questions
 Provide diverational therapy
Anxiety related to intensive care environment and invasive
procedures.

38. COMPLICATIONS
COMA
BRAINDAMAGE
MULTIPLE ORGAN FAILURE
KIDNEY DAMAGE
LIVER DAMAGE
DEATH
.

39. Cardiogenic shock is a treatable illness with a
reasonable chance for full recovery. The Cardiogenic
shock literature has traditionally focused on the very
high mortality associated with this diagnosis. It is
important to recognize that although patients with
Cardiogenic shock are at very high risk for early death,
great potential exists for salvage.
CONCLUSION

40. Chintamani, Lewis, Text book of Medical surgical
Nursing, Elsevier Publication 13 th edition. volume 1.
2011.pg no 1723-1725.
Black.M.Joyce.Text book of Medical SurgIcal
N.Elsevier Publication.8 th edition .PG . No 2134 3136.
Griffin .P.Brain, Manaul of Cardiovascular Medicine.
Lippincott punbllication.4 th edition. volume 1. pg no
77 to 80.
BIBILIOGRAPHY