Reperfusion in cardiogenic shock
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Cardiogenic shock occurs in 6% of STEMI and 3% of NSTE ACS patients and has a high mortality rate of 60-80% without treatment. Early recognition and prompt revascularization through procedures like PCI or CABG can improve survival. The SHOCK trial found that emergency revascularization led to lower 6-month mortality compared to initial medical stabilization. For cardiogenic shock patients, international recommendations suggest revascularization over fibrinolysis when possible due to limited evidence of fibrinolysis effectiveness in this context.
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Cardiogenic shock
The document discusses cardiogenic shock, which occurs in 5-8% of patients hospitalized with ST elevation myocardial infarction (STEMI). It describes the pathophysiology, criteria for diagnosis, causes, clinical presentation, investigations including echocardiography and pulmonary artery catheterization, management with inotropes, vasopressors, IABP, and early revascularization, as well as prognosis. Early revascularization via PCI or CABG within 18 hours of shock improves survival substantially. Newer mechanical support devices such as percutaneous LVADs are promising but limited by complications. Most hospital survivors have excellent long term survival and quality of life.
Cardiogenic shock
This document provides an overview of cardiogenic shock, including its definition, pathophysiology, etiology, clinical presentation, diagnosis, and management. Cardiogenic shock is defined as inadequate tissue perfusion due to the heart's inability to pump an adequate amount of blood, despite adequate intravascular volume. It results from a severe reduction in cardiac output and stroke volume. The most common cause is severe left ventricular dysfunction following acute myocardial infarction, though right ventricular failure can also cause cardiogenic shock. Management involves general support measures, pharmacological therapy including inotropes and vasopressors, hemodynamic management, mechanical support such as IABP, and early reperfusion when possible. Early invasive management and avoidance of excessive fluids for right
Cardiogenic shock - Anesthesiology and ICU
Cardiogenic shock is characterized by low cardiac output and tissue hypoxia due to inadequate pumping function of the heart. It is a leading cause of death for acute myocardial infarction patients without aggressive medical care. Clinically, cardiogenic shock patients appear pale with cool skin and demonstrate signs of hypoperfusion. Treatment involves fluid resuscitation, inotropes to support blood pressure, mechanical circulatory support like IABP, and most importantly reversal of the underlying cause through procedures like PCI or CABG. While supportive care buys time, definitive treatment of the precipitating cardiac problem is needed for long term recovery from cardiogenic shock.
Heart Disease & Chest Pain Treatment At NT Cardiovascular Center Georgia
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Cardiogenic shock
This document discusses the current management of cardiogenic shock. It defines cardiogenic shock and describes its causes, predictors of mortality, and pathophysiology. Treatment involves hemodynamic support, volume management, inotropic drugs, and early revascularization, which significantly reduces mortality. Mechanical circulatory support devices like IABP, Tandem Heart, Impella, and ECMO can further improve hemodynamics and outcomes when used as adjuncts to optimal medical therapy. Timing of revascularization is critical, with survival benefits seen for up to 48 hours after myocardial infarction onset. Special considerations are discussed for managing shock in the elderly, from mechanical causes, and with specific device therapies.
cardiogenic shock
A 38-year-old female presented to the emergency room with severe headache, shortness of breath, dizziness, confusion, nausea and palpitations. She has a history of hypertension and was diagnosed with a myocardial infarction one week ago. Evaluation showed signs of cardiogenic shock. The plan is to perform ECG, CT scan, echocardiogram, cardiac enzymes, blood gas analysis and V/Q scan. The learning goals are to discuss cardiogenic shock, its causes, clinical presentation, diagnosis and treatment.
Cardiogenic Shock
The document discusses cardiogenic shock, which results from inadequate tissue perfusion due to cardiac dysfunction. Cardiogenic shock is defined by a sustained systolic blood pressure below 90 mm Hg, cardiac index below 2.2 L/min/m2, and pulmonary capillary wedge pressure above 15 mm Hg. Causes of cardiogenic shock include acute myocardial infarction, mechanical complications, right ventricular infarction, and other conditions such as cardiomyopathy. The pathophysiology and management of cardiogenic shock are discussed.
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02
1) Cardiogenic shock is a clinical condition caused by the heart's inability to pump an adequate amount of blood to vital organs, resulting in inadequate tissue perfusion.
2) The document discusses the causes, pathophysiology, clinical manifestations, diagnosis, and management of cardiogenic shock, with a focus on cardiogenic shock caused by acute myocardial infarction.
3) Early revascularization through percutaneous coronary intervention or coronary artery bypass grafting is recommended for suitable patients with cardiogenic shock due to acute myocardial infarction, along with supportive therapies like intra-aortic balloon pump counterpulsation or ventricular assist devices.
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Cardiogenic shock
The document discusses cardiogenic shock, which occurs in 5-8% of patients hospitalized with ST elevation myocardial infarction (STEMI). It describes the pathophysiology, criteria for diagnosis, causes, clinical presentation, investigations including echocardiography and pulmonary artery catheterization, management with inotropes, vasopressors, IABP, and early revascularization, as well as prognosis. Early revascularization via PCI or CABG within 18 hours of shock improves survival substantially. Newer mechanical support devices such as percutaneous LVADs are promising but limited by complications. Most hospital survivors have excellent long term survival and quality of life.
Cardiogenic shock
This document provides an overview of cardiogenic shock, including its definition, pathophysiology, etiology, clinical presentation, diagnosis, and management. Cardiogenic shock is defined as inadequate tissue perfusion due to the heart's inability to pump an adequate amount of blood, despite adequate intravascular volume. It results from a severe reduction in cardiac output and stroke volume. The most common cause is severe left ventricular dysfunction following acute myocardial infarction, though right ventricular failure can also cause cardiogenic shock. Management involves general support measures, pharmacological therapy including inotropes and vasopressors, hemodynamic management, mechanical support such as IABP, and early reperfusion when possible. Early invasive management and avoidance of excessive fluids for right
Cardiogenic shock - Anesthesiology and ICU
Cardiogenic shock is characterized by low cardiac output and tissue hypoxia due to inadequate pumping function of the heart. It is a leading cause of death for acute myocardial infarction patients without aggressive medical care. Clinically, cardiogenic shock patients appear pale with cool skin and demonstrate signs of hypoperfusion. Treatment involves fluid resuscitation, inotropes to support blood pressure, mechanical circulatory support like IABP, and most importantly reversal of the underlying cause through procedures like PCI or CABG. While supportive care buys time, definitive treatment of the precipitating cardiac problem is needed for long term recovery from cardiogenic shock.
Heart Disease & Chest Pain Treatment At NT Cardiovascular Center Georgia
http://www.ntcardiovascularcenter.com NT Cardiovascular Center providing latest cutting edge and comprehensive technology for heart disease, chest pain treatments, congestive heart failure, coronary artery disease monitoring, or any critical heart condition.
Cardiogenic shock
This document discusses the current management of cardiogenic shock. It defines cardiogenic shock and describes its causes, predictors of mortality, and pathophysiology. Treatment involves hemodynamic support, volume management, inotropic drugs, and early revascularization, which significantly reduces mortality. Mechanical circulatory support devices like IABP, Tandem Heart, Impella, and ECMO can further improve hemodynamics and outcomes when used as adjuncts to optimal medical therapy. Timing of revascularization is critical, with survival benefits seen for up to 48 hours after myocardial infarction onset. Special considerations are discussed for managing shock in the elderly, from mechanical causes, and with specific device therapies.
cardiogenic shock
A 38-year-old female presented to the emergency room with severe headache, shortness of breath, dizziness, confusion, nausea and palpitations. She has a history of hypertension and was diagnosed with a myocardial infarction one week ago. Evaluation showed signs of cardiogenic shock. The plan is to perform ECG, CT scan, echocardiogram, cardiac enzymes, blood gas analysis and V/Q scan. The learning goals are to discuss cardiogenic shock, its causes, clinical presentation, diagnosis and treatment.
Cardiogenic Shock
The document discusses cardiogenic shock, which results from inadequate tissue perfusion due to cardiac dysfunction. Cardiogenic shock is defined by a sustained systolic blood pressure below 90 mm Hg, cardiac index below 2.2 L/min/m2, and pulmonary capillary wedge pressure above 15 mm Hg. Causes of cardiogenic shock include acute myocardial infarction, mechanical complications, right ventricular infarction, and other conditions such as cardiomyopathy. The pathophysiology and management of cardiogenic shock are discussed.
Cardiogenicshock by Dr.Afroza Prioty -140123092109-phpapp02
1) Cardiogenic shock is a clinical condition caused by the heart's inability to pump an adequate amount of blood to vital organs, resulting in inadequate tissue perfusion.
2) The document discusses the causes, pathophysiology, clinical manifestations, diagnosis, and management of cardiogenic shock, with a focus on cardiogenic shock caused by acute myocardial infarction.
3) Early revascularization through percutaneous coronary intervention or coronary artery bypass grafting is recommended for suitable patients with cardiogenic shock due to acute myocardial infarction, along with supportive therapies like intra-aortic balloon pump counterpulsation or ventricular assist devices.
Cardiogenic shock 1
This document provides information on the management of cardiogenic shock. It begins with a case presentation of a 72-year-old male brought to the emergency department with sudden onset chest pain and symptoms of shock. It then defines cardiogenic shock and discusses its causes, risk factors, diagnosis, and treatment modalities. Treatment involves managing reversible causes, vasopressors, mechanical support like intra-aortic balloon pumps or ventricular assist devices, and permanent measures such as fibrinolysis, revascularization, or transplantation. The document reviews various hemodynamic support devices and their indications.
Cardiogenic Shock And Arrhythmias
The document discusses several topics related to acute coronary syndrome including cardiogenic shock, acute myocardial infarction, congestive heart failure, and arrhythmias. It provides definitions and pathophysiology of cardiogenic shock, acute coronary syndrome, and discusses management strategies including use of inotropes, vasopressors, intra-aortic balloon pump counterpulsation, and revascularization. It also discusses definitions and management of acute coronary syndromes including unstable angina and myocardial infarction and the role of antiplatelet and anticoagulation therapies.
Lec 4 management of cardiogenic shock for mohs
Cardiogenic shock is a life-threatening condition occurring in 4-15% of acute myocardial infarction cases, with a high mortality rate of 50%. It is defined as impaired organ perfusion due to reduced cardiac output and low blood pressure. Treatment involves general supportive measures, inotropic drugs, revascularization procedures, and mechanical circulatory support devices to increase blood pressure and cardiac output. With early reperfusion therapy and intensive care, mortality from cardiogenic shock complicating acute coronary syndrome can be reduced to around 40%.
CARDIOGENIC SHOCK
Cardiogenic shock is defined as inadequate tissue perfusion due to cardiac dysfunction or hypo-perfusion of end organs due to cardiac failure. It has a high mortality rate of 50-80% and is most commonly caused by extensive acute myocardial infarction. Symptoms include cyanosis, decreased consciousness, and low blood pressure. Diagnosis involves identifying hypotension, low cardiac index, and signs of hypoperfusion on physical exam along with supportive tests like EKG, echocardiogram, and Swan-Ganz catheter. Treatment focuses on optimizing prefusion with vasopressors or inotropes, diuretics, emergent revascularization through cardiac catheterization, and mechanical circulatory support like IABP,
Cardiogenic shock
This document describes the case of a 74-year-old female patient who presented to the emergency department with acute dyspnea and respiratory distress. Initial workup revealed signs of congestion on chest x-ray and elevated troponin levels. Her condition deteriorated rapidly, and echocardiogram showed widespread hypokinesis consistent with Takotsubo cardiomyopathy. She was transferred urgently to a primary PCI center where coronary angiogram confirmed the diagnosis. She was started on inotropic support and recovered without further intervention. The key lessons are to promptly perform echocardiography and ECG for patients in cardiogenic shock, provide inotropic support and vasopressors as needed, and rapidly transfer patients to centers
Myocardial infarction
Myocardial infarction, also known as a heart attack, occurs when an area of heart muscle is damaged due to inadequate blood flow. It is usually caused by atherosclerosis leading to narrowing or blockage of the coronary arteries. The left anterior descending artery supplies the anterior and septal walls of the heart, while the circumflex artery supplies the posterior and lateral walls. Obstruction of these arteries results in different types of MIs in the respective regions. Risk factors include age over 40, family history, male sex, obesity, diabetes, smoking, and hypertension. Symptoms include chest pain and potential radiation to the arm or shoulder. Diagnostic tests include electrocardiograms, cardiac enzymes, angiography, and imaging scans.
Cardiogenic shock
This document provides an overview of cardiogenic shock (CS) from an internal medicine perspective. It aims to provide a clinical "toolbox" for diagnosing, differentiating, and managing shock, with an emphasis on cardiovascular etiologies. Part I discusses the initial evaluation of a hypotensive patient in shock, including assessing cardiac rhythm and rate, conducting a physical exam, and raising blood pressure by administering fluids. Part II notes that further consideration is needed when treating CS, such as feeling free to drift off. The document discusses evaluating objective data, differentiating shock types, selecting appropriate pressors/inotropes, and controversies regarding first-line vasoactive agents.
Cardiogenic shock aha 2019
Cardiogenic shock is caused by severe impairment of myocardial function leading to low cardiac output and organ hypoperfusion. It commonly results from acute myocardial infarction and presents as hypotension refractory to fluids with signs of poor organ perfusion. Definitions of cardiogenic shock require hypotension, evidence of end-organ damage, and suspected cardiac dysfunction. Treatment involves revascularization, inotropes, vasopressors, and mechanical circulatory support.
Management of Cardiogenic shock
Management of Cardiogenic shock Dr Noor E Khuda Topu,MD thesis part Student cardiology,Dhaka Medical College Hospital
Inotropes and vasopressors in cardiogenic shock
This document discusses the use of inotropes and vasopressors in the treatment of cardiogenic shock. It provides definitions of cardiogenic shock and describes signs of tissue hypoperfusion. It then outlines an approach to assessing patients with acute heart failure based on congestion and perfusion status. For patients who are "wet and cold", it recommends inotropic agents such as dobutamine or vasopressors like norepinephrine to increase blood pressure and cardiac output. The mechanisms, effects, advantages, and disadvantages of various inotropes including dobutamine, dopamine, norepinephrine, epinephrine, milrinone, and levosimendan are then compared. Clinical evidence supporting the
Cardiogenic shock
Cardiogenic shock is characterized by decreased tissue perfusion and impaired cellular metabolism. It progresses through four stages as the body attempts compensation. The compensatory stage involves nervous, hormonal and chemical responses to shunt blood to vital organs. In the progressive stage, compensatory mechanisms begin to cause problems by failing to maintain cardiac output. Cardiogenic shock is divided into coronary and non-coronary types. Clinical signs include pale skin, tachycardia, weak pulses and decreased urine output. Treatment goals are to improve tissue perfusion, decrease myocardial oxygen demand, improve contractility and decrease infarct size using fluids, inotropes, vasopressors and IABP as needed.
Acute coronary syndrome for critical care exam
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
ST- Segment Elevation Myocardial Infarction
- ST-segment elevation myocardial infarction (STEMI) occurs when a coronary artery becomes occluded by a thrombus, blocking blood flow and damaging heart muscle. It is a medical emergency associated with high mortality.
- The electrocardiogram (ECG) is used to diagnose STEMI based on ST-segment elevation. Treatment aims to rapidly restore blood flow through fibrinolysis or percutaneous coronary intervention to limit heart muscle damage.
- Aspirin, oxygen, nitroglycerin and morphine are given to relieve chest pain and reduce oxygen demand while awaiting reperfusion. Beta blockers may also be used if the blood pressure is stable enough.
Cardiogenic shock
Cardiogenic shock is defined as acute heart failure secondary to a myocardial infarction, resulting in critical end organ hypoperfusion and a mortality rate over 50%. It is characterized by increased cardiac filling pressures but decreased cardiac output. Therapy aims to restore cardiac output and treat underlying causes like hypoxia, arrhythmias, hypervolemia, coronary ischemia, or acidosis. The leading cause of death in cardiogenic shock patients is multiple organ failure. Diagnosis is based on signs of weakness, fatigue, dyspnea, elevated jugular venous pressure, gallops, murmurs, or peripheral edema. Coronary angiography and revascularization are usually required within 18 hours of shock onset. Treatment involves vasopressors like nore
Cardiogenic shock
Cardiogenic shock occurs when the heart is damaged and unable to pump enough blood to vital organs. This causes blood pressure to drop and organs to fail. It is a serious medical emergency. The heart loses its ability to contract effectively due to lack of oxygen and nutrients. Clinical features include low blood pressure, confusion, and poor organ perfusion. Treatment aims to improve cardiac function and oxygen delivery through medications, surgeries like bypass and stenting, and devices like intra-aortic balloon pumps. Nursing care monitors the patient's condition and supports the medical management of this critical condition.
Advance cardiac life support review
REVIEW advance cardiac life support
ITS PREPARE YOU TO GET ACLS CERTIFICATE
FOR STUDENT AND NURSE PRACTITIONER
READ THIS AND PRACTICE
GOOD LUCK
Congestive heart failure
Shortness of breath is the main symptom of congestive heart failure (CHF), which occurs when the heart cannot pump enough blood to meet the body's needs. CHF can be caused by systolic or diastolic dysfunction and is commonly due to hypertension, valvular heart disease, or myocardial infarction. Diagnosis is made clinically based on symptoms like orthopnea, edema, and gallop rhythm, with echocardiography used to evaluate ejection fraction and determine type of dysfunction. Treatment depends on ejection fraction, but may include ACE inhibitors, beta blockers, spironolactone, diuretics, and devices like defibrillators.
Cardiogenic shock
Cardiogenic shock is a life-threatening medical condition where the heart is unable to pump enough blood to meet the body's needs due to severe damage to the heart muscle, usually from a major heart attack. It can cause very low blood pressure and organ damage or failure if not treated quickly. Treatments focus on restoring blood flow through the heart with medications, medical procedures like angioplasty and stenting, or surgeries like coronary bypass if needed. The goal is to improve the heart's ability to pump and increase blood pressure before organ damage becomes permanent or the patient dies.
Shock Trial
This document summarizes a study reporting on patients experiencing cardiogenic shock following acute myocardial infarction. The study analyzed 1,190 patients registered in the SHOCK Trial Registry between 1993-1997. It found that predominant left ventricular failure was the most common cause of shock (78.5%), while mechanical complications like ventricular septal rupture or tamponade caused shock in about 12% of cases. In-hospital mortality was 60% overall but higher at 87.3% for patients with ventricular septal rupture. Outcomes were better for patients receiving treatments like thrombolysis, intra-aortic balloon counterpulsation, coronary angiography, angioplasty or bypass surgery. After adjusting for treatments, early revascularization was found to
Hemorrhagic shock
Hemorrhagic shock is a type of hypovolemic shock caused by severe blood loss that leads to inadequate oxygen delivery at the cellular level. Causes include trauma, postpartum hemorrhage, gastrointestinal bleeding, aneurysm rupture, and perioperative bleeding. As blood is lost, compensatory mechanisms maintain blood pressure initially but eventually fail as more than 20-30% of blood volume is lost, leading to lethal exsanguination with more than 30% blood loss. Management involves securing the airway, stopping bleeding, restoring volume with blood products rather than crystalloids, and monitoring endpoints like lactate and urine output to guide resuscitation.
Acute STEMI Rx.pptx
1. The document discusses the current standard of care for acute ST elevation myocardial infarction (STEMI), including definitions, classifications, pre-hospital and initial management, and reperfusion options.
2. Timely reperfusion therapy, either through fibrinolysis or primary percutaneous coronary intervention (PCI), is essential to reduce infarct size and mortality. The goal is to restore flow in the infarct-related artery within 90 minutes of first medical contact.
3. Initial medical therapies in the emergency department include aspirin, clopidogrel, heparin, statins, nitrates, beta blockers, morphine, and supplemental oxygen as needed. Risk stratification helps guide management.
4. Fibrin
Stroke management
an updated account on management of TIA, Ischemic and hemorrhagic stroke in Sri Lanka. This is based on American Stroke Association and NICE guidelines.
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Cardiogenic shock 1
This document provides information on the management of cardiogenic shock. It begins with a case presentation of a 72-year-old male brought to the emergency department with sudden onset chest pain and symptoms of shock. It then defines cardiogenic shock and discusses its causes, risk factors, diagnosis, and treatment modalities. Treatment involves managing reversible causes, vasopressors, mechanical support like intra-aortic balloon pumps or ventricular assist devices, and permanent measures such as fibrinolysis, revascularization, or transplantation. The document reviews various hemodynamic support devices and their indications.
Cardiogenic Shock And Arrhythmias
The document discusses several topics related to acute coronary syndrome including cardiogenic shock, acute myocardial infarction, congestive heart failure, and arrhythmias. It provides definitions and pathophysiology of cardiogenic shock, acute coronary syndrome, and discusses management strategies including use of inotropes, vasopressors, intra-aortic balloon pump counterpulsation, and revascularization. It also discusses definitions and management of acute coronary syndromes including unstable angina and myocardial infarction and the role of antiplatelet and anticoagulation therapies.
Lec 4 management of cardiogenic shock for mohs
Cardiogenic shock is a life-threatening condition occurring in 4-15% of acute myocardial infarction cases, with a high mortality rate of 50%. It is defined as impaired organ perfusion due to reduced cardiac output and low blood pressure. Treatment involves general supportive measures, inotropic drugs, revascularization procedures, and mechanical circulatory support devices to increase blood pressure and cardiac output. With early reperfusion therapy and intensive care, mortality from cardiogenic shock complicating acute coronary syndrome can be reduced to around 40%.
CARDIOGENIC SHOCK
Cardiogenic shock is defined as inadequate tissue perfusion due to cardiac dysfunction or hypo-perfusion of end organs due to cardiac failure. It has a high mortality rate of 50-80% and is most commonly caused by extensive acute myocardial infarction. Symptoms include cyanosis, decreased consciousness, and low blood pressure. Diagnosis involves identifying hypotension, low cardiac index, and signs of hypoperfusion on physical exam along with supportive tests like EKG, echocardiogram, and Swan-Ganz catheter. Treatment focuses on optimizing prefusion with vasopressors or inotropes, diuretics, emergent revascularization through cardiac catheterization, and mechanical circulatory support like IABP,
Cardiogenic shock
This document describes the case of a 74-year-old female patient who presented to the emergency department with acute dyspnea and respiratory distress. Initial workup revealed signs of congestion on chest x-ray and elevated troponin levels. Her condition deteriorated rapidly, and echocardiogram showed widespread hypokinesis consistent with Takotsubo cardiomyopathy. She was transferred urgently to a primary PCI center where coronary angiogram confirmed the diagnosis. She was started on inotropic support and recovered without further intervention. The key lessons are to promptly perform echocardiography and ECG for patients in cardiogenic shock, provide inotropic support and vasopressors as needed, and rapidly transfer patients to centers
Myocardial infarction
Myocardial infarction, also known as a heart attack, occurs when an area of heart muscle is damaged due to inadequate blood flow. It is usually caused by atherosclerosis leading to narrowing or blockage of the coronary arteries. The left anterior descending artery supplies the anterior and septal walls of the heart, while the circumflex artery supplies the posterior and lateral walls. Obstruction of these arteries results in different types of MIs in the respective regions. Risk factors include age over 40, family history, male sex, obesity, diabetes, smoking, and hypertension. Symptoms include chest pain and potential radiation to the arm or shoulder. Diagnostic tests include electrocardiograms, cardiac enzymes, angiography, and imaging scans.
Cardiogenic shock
This document provides an overview of cardiogenic shock (CS) from an internal medicine perspective. It aims to provide a clinical "toolbox" for diagnosing, differentiating, and managing shock, with an emphasis on cardiovascular etiologies. Part I discusses the initial evaluation of a hypotensive patient in shock, including assessing cardiac rhythm and rate, conducting a physical exam, and raising blood pressure by administering fluids. Part II notes that further consideration is needed when treating CS, such as feeling free to drift off. The document discusses evaluating objective data, differentiating shock types, selecting appropriate pressors/inotropes, and controversies regarding first-line vasoactive agents.
Cardiogenic shock aha 2019
Cardiogenic shock is caused by severe impairment of myocardial function leading to low cardiac output and organ hypoperfusion. It commonly results from acute myocardial infarction and presents as hypotension refractory to fluids with signs of poor organ perfusion. Definitions of cardiogenic shock require hypotension, evidence of end-organ damage, and suspected cardiac dysfunction. Treatment involves revascularization, inotropes, vasopressors, and mechanical circulatory support.
Management of Cardiogenic shock
Management of Cardiogenic shock Dr Noor E Khuda Topu,MD thesis part Student cardiology,Dhaka Medical College Hospital
Inotropes and vasopressors in cardiogenic shock
This document discusses the use of inotropes and vasopressors in the treatment of cardiogenic shock. It provides definitions of cardiogenic shock and describes signs of tissue hypoperfusion. It then outlines an approach to assessing patients with acute heart failure based on congestion and perfusion status. For patients who are "wet and cold", it recommends inotropic agents such as dobutamine or vasopressors like norepinephrine to increase blood pressure and cardiac output. The mechanisms, effects, advantages, and disadvantages of various inotropes including dobutamine, dopamine, norepinephrine, epinephrine, milrinone, and levosimendan are then compared. Clinical evidence supporting the
Cardiogenic shock
Cardiogenic shock is characterized by decreased tissue perfusion and impaired cellular metabolism. It progresses through four stages as the body attempts compensation. The compensatory stage involves nervous, hormonal and chemical responses to shunt blood to vital organs. In the progressive stage, compensatory mechanisms begin to cause problems by failing to maintain cardiac output. Cardiogenic shock is divided into coronary and non-coronary types. Clinical signs include pale skin, tachycardia, weak pulses and decreased urine output. Treatment goals are to improve tissue perfusion, decrease myocardial oxygen demand, improve contractility and decrease infarct size using fluids, inotropes, vasopressors and IABP as needed.
Acute coronary syndrome for critical care exam
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
ST- Segment Elevation Myocardial Infarction
- ST-segment elevation myocardial infarction (STEMI) occurs when a coronary artery becomes occluded by a thrombus, blocking blood flow and damaging heart muscle. It is a medical emergency associated with high mortality.
- The electrocardiogram (ECG) is used to diagnose STEMI based on ST-segment elevation. Treatment aims to rapidly restore blood flow through fibrinolysis or percutaneous coronary intervention to limit heart muscle damage.
- Aspirin, oxygen, nitroglycerin and morphine are given to relieve chest pain and reduce oxygen demand while awaiting reperfusion. Beta blockers may also be used if the blood pressure is stable enough.
Cardiogenic shock
Cardiogenic shock is defined as acute heart failure secondary to a myocardial infarction, resulting in critical end organ hypoperfusion and a mortality rate over 50%. It is characterized by increased cardiac filling pressures but decreased cardiac output. Therapy aims to restore cardiac output and treat underlying causes like hypoxia, arrhythmias, hypervolemia, coronary ischemia, or acidosis. The leading cause of death in cardiogenic shock patients is multiple organ failure. Diagnosis is based on signs of weakness, fatigue, dyspnea, elevated jugular venous pressure, gallops, murmurs, or peripheral edema. Coronary angiography and revascularization are usually required within 18 hours of shock onset. Treatment involves vasopressors like nore
Cardiogenic shock
Cardiogenic shock occurs when the heart is damaged and unable to pump enough blood to vital organs. This causes blood pressure to drop and organs to fail. It is a serious medical emergency. The heart loses its ability to contract effectively due to lack of oxygen and nutrients. Clinical features include low blood pressure, confusion, and poor organ perfusion. Treatment aims to improve cardiac function and oxygen delivery through medications, surgeries like bypass and stenting, and devices like intra-aortic balloon pumps. Nursing care monitors the patient's condition and supports the medical management of this critical condition.
Advance cardiac life support review
REVIEW advance cardiac life support
ITS PREPARE YOU TO GET ACLS CERTIFICATE
FOR STUDENT AND NURSE PRACTITIONER
READ THIS AND PRACTICE
GOOD LUCK
Congestive heart failure
Shortness of breath is the main symptom of congestive heart failure (CHF), which occurs when the heart cannot pump enough blood to meet the body's needs. CHF can be caused by systolic or diastolic dysfunction and is commonly due to hypertension, valvular heart disease, or myocardial infarction. Diagnosis is made clinically based on symptoms like orthopnea, edema, and gallop rhythm, with echocardiography used to evaluate ejection fraction and determine type of dysfunction. Treatment depends on ejection fraction, but may include ACE inhibitors, beta blockers, spironolactone, diuretics, and devices like defibrillators.
Cardiogenic shock
Cardiogenic shock is a life-threatening medical condition where the heart is unable to pump enough blood to meet the body's needs due to severe damage to the heart muscle, usually from a major heart attack. It can cause very low blood pressure and organ damage or failure if not treated quickly. Treatments focus on restoring blood flow through the heart with medications, medical procedures like angioplasty and stenting, or surgeries like coronary bypass if needed. The goal is to improve the heart's ability to pump and increase blood pressure before organ damage becomes permanent or the patient dies.
Shock Trial
This document summarizes a study reporting on patients experiencing cardiogenic shock following acute myocardial infarction. The study analyzed 1,190 patients registered in the SHOCK Trial Registry between 1993-1997. It found that predominant left ventricular failure was the most common cause of shock (78.5%), while mechanical complications like ventricular septal rupture or tamponade caused shock in about 12% of cases. In-hospital mortality was 60% overall but higher at 87.3% for patients with ventricular septal rupture. Outcomes were better for patients receiving treatments like thrombolysis, intra-aortic balloon counterpulsation, coronary angiography, angioplasty or bypass surgery. After adjusting for treatments, early revascularization was found to
Hemorrhagic shock
Hemorrhagic shock is a type of hypovolemic shock caused by severe blood loss that leads to inadequate oxygen delivery at the cellular level. Causes include trauma, postpartum hemorrhage, gastrointestinal bleeding, aneurysm rupture, and perioperative bleeding. As blood is lost, compensatory mechanisms maintain blood pressure initially but eventually fail as more than 20-30% of blood volume is lost, leading to lethal exsanguination with more than 30% blood loss. Management involves securing the airway, stopping bleeding, restoring volume with blood products rather than crystalloids, and monitoring endpoints like lactate and urine output to guide resuscitation.
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3. Initial medical therapies in the emergency department include aspirin, clopidogrel, heparin, statins, nitrates, beta blockers, morphine, and supplemental oxygen as needed. Risk stratification helps guide management.
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The document discusses recent evidence for mechanical thrombectomy in acute ischemic stroke. It summarizes several recent randomized controlled trials that compared mechanical thrombectomy using stent retrievers to standard medical therapy alone. The trials showed that mechanical thrombectomy significantly improved rates of reperfusion and functional independence, with absolute increases in good clinical outcomes ranging from 13.5% to 31.4%. Mechanical thrombectomy also reduced mortality in some trials. Based on these results, international guidelines now recommend endovascular therapy with stent retrievers for appropriately selected patients within 6 hours of stroke onset.
Presentation1.pptx
Transient ischemic attacks (TIAs) require urgent evaluation due to the high risk of stroke. A TIA is diagnosed using scales like the ABCD2 score and differentiated from conditions like seizures or migraines. The National Stroke Association recommends factors like symptom duration over 1 hour or carotid stenosis over 50% warrant hospitalization. For diagnosed strokes, treatments include IV alteplase within 4.5 hours, mechanical thrombectomy if eligible, and supportive care involving blood pressure and glucose control. Secondary prevention incorporates antithrombotics, treating underlying conditions, and lifestyle changes.
MANAGEMENT OF ACUTE STROKE
Stroke is a leading cause of death and disability. All doctors should have a basic knowledge about stroke management. This presentation gives a summary of treatment options in acute brain stroke.
Acute Coronary syndrome - Pharmacotherapy
Acute coronary syndrome (ACS) results from an imbalance between myocardial oxygen supply and demand due to diminished blood flow from an occlusive coronary artery thrombus. ACS is classified as ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS), which includes non-STEMI and unstable angina. Treatment involves antiplatelet and anticoagulant medications, revascularization procedures like percutaneous coronary intervention (PCI), and lifestyle modifications to prevent recurrent events.
Spontaneous intracerebral hemorrhage
Intracerebral hemorrhage is an acute extravasation of blood into the brain parenchyma that may extend into ventricles or subarachnoid space. It accounts for 10-15% of strokes and has a 6-month mortality rate of 30-50%. The most common causes are hypertension (78-88%) and cerebral amyloid angiopathy. Treatment involves controlling blood pressure, treating the underlying cause, preventing hematoma expansion, and managing complications. While early surgery was not shown to improve outcomes in the overall STICH trial, it may be beneficial for lobar hemorrhages, which ISTICH-II aims to further evaluate.
Damage control resuscitation
Damage Control Resuscitation (DCR) is a systematic approach for managing major trauma patients at risk of exsanguinating hemorrhage. It incorporates permissive hypotension to minimize blood loss while hemorrhage is uncontrolled, haemostatic resuscitation using blood products instead of crystalloids to prevent coagulopathy, and early hemorrhage control through surgery. DCR aims to decrease mortality and morbidity by recognizing patients at risk of hemorrhagic shock, providing adequate tissue oxygenation through hypotensive resuscitation while limiting further blood loss and clot disruption, and preventing the triad of hypothermia, acidosis and coagulopathy through haemostatic resuscitation and blood product administration according to a
HTN & CVA.pptx
This document discusses hypertension and its relationship to stroke. It covers several key points:
1. Hypertension is a major risk factor for stroke, responsible for 10% of deaths in India, with 51% of stroke deaths due to hypertension. Both systolic and diastolic blood pressure are strongly correlated with stroke risk.
2. Acute blood pressure management in ischemic stroke is complex, as both extreme hypertension and induced hypotension can be detrimental by disrupting cerebral blood flow. Moderate control to less than 220/120 mmHg is recommended when possible.
3. In intracerebral hemorrhage, elevated blood pressure increases hematoma expansion risk in the first hours, so aggressive control to less
SUBARACHNOID HEMORRHAGE
1. A 50-year-old female smoker with hypertension presented with sudden severe headache and brief loss of consciousness at work. She was found to have subarachnoid hemorrhage.
2. Subarachnoid hemorrhage is a neurological emergency caused by bleeding into the subarachnoid space, usually from a ruptured berry aneurysm. It requires rapid diagnosis and treatment to prevent rebleeding, vasospasm, and other complications.
3. Diagnostic tests included a non-contrast CT, which was positive, as well as a CTA and lumbar puncture to confirm the diagnosis and identify the source of bleeding. The patient was treated supportively in the ICU to control
Hypertension and stroke
This was lecture given at College of General Practitioner Hyderabad on 16th June 2013 as refresher course on Hypertension
Management of acute ischemic stroke (2013 aha
Stroke is the 4th leading cause of death in the US. Less than 50% of stroke patients call 911 within an hour of symptoms and are transported to the most appropriate hospital. Public education on stroke signs is a priority. The document outlines recommendations for stroke diagnosis and treatment including patient positioning, oxygenation, temperature control, blood pressure and sugar management, fibrinolysis with rtPA within 3-4.5 hours, anticoagulation, antiplatelets, and preventing complications. Decompressive surgery is recommended for large hemispheric or cerebellar infarcts to reduce mortality. Thromboprophylaxis is also discussed for traumatic brain injury patients.
STEMI F5.pptx
- STEMI is a major cause of morbidity and mortality globally and in Saudi Arabia due to increasing risk factors. Only 42% of STEMI patients undergo primary PCI (PPCI) in Saudi Arabia, with only 62% achieving door-to-balloon times under 90 minutes. Mortality is influenced by factors like age, time to treatment, and presence of STEMI networks. PPCI is the preferred reperfusion strategy over fibrinolytics when possible. Guidelines recommend antiplatelet and anticoagulation medications during PPCI and secondary prevention medications like statins long-term.
Hemodynamic Management afer Cardiac Arrest
Hypotension is common after cardiac arrest due to factors like stunned myocardium. Post-cardiac arrest patients are vulnerable to hypoperfusion which can worsen outcomes. Hemodynamic support is critical to support neurological recovery, especially in the initial 6-24 hours, but vasopressors can paradoxically worsen cerebral blood flow. Characterizing the cause of shock, such as through echocardiogram or CT, helps determine optimal hemodynamic management including temperature targets, vasopressors, and consideration of mechanical support like ECMO if cardiac output is failing. A multidisciplinary discussion is important for complex post-cardiac arrest patients in shock.
Acute coronary syndrome (acs)
Acute coronary syndrome (ACS) refers to a spectrum of conditions caused by reduced blood flow in the coronary arteries. This includes unstable angina, non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). STEMI is diagnosed based on specific ECG findings and requires urgent reperfusion therapy. Initial management involves pain control, antithrombotic therapy, and reperfusion with either primary PCI or thrombolysis to limit infarct size.
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Reperfusion in cardiogenic shock
- 1. Reperfusion Therapy in Cardiogenic Shock after MI By Dr.Hamdy abdalla Badawy
- 2. Cardiogenic Shock • One of the most common causes of death after an MI. • Mostly occurs < 48 hrs after hospitalization, rather at presentation (90% vs 4.5%). • About 6% of STEMI, 3% of NSTE ACS patients. • 60-80 % mortality (pre thrombolytic), • Survival at 3yrs and 6 yrs – 40% and 30% respectively. • Early recognition, prompt revascularization helps in improved survival
- 3. Definition • Marked and persistent (>30 min) hypotension • SBP < 90 mmHg, or • Drop in SBP by 30 mm Hg below basal levels, or • Supportive pharmacotherapy required to maintain SBP > 90 mm Hg. • Reduced cardiac index (<2.2 liters/min/m2) • signs of impaired organ perfusion (altered mental status,cold extremeties,oliguria)
- 4. CAD patients at risk… • Extensive Anterior wall STEMI • LMCA stenosis + previous LVDysfunction. • Osteoproximal LAD total occlusion. • LAD + Previous h/o CAD. • TVD + Diabetes.
- 5. SHOCK trial • Patients were randomly assigned to emergency revascularization (PCI or emergent CABG) or initial medical stabilization, including fibrinolysis. • Overall mortality at 30 days did not differ significantly between the revascularization and medical therapy groups. Six-month mortality was lower in the revascularization group than in the medical therapy group • lower mortality from all causes at 6 months. (50.3 % vs. 63.1 %, P=0.027). • Early revascularization be strongly considered for patients with Acute Myocardial Infarction complicated by cardiogenic shock
- 6. Why thrombolysis not effective? Fibrinolysis is not effective in these patients owing to : • Limited evidence. • Complex mechanical, hemodynamic ,metabolic factors. • Acidosis - impaired transformation of plasminogen to plasmin - decreased efficacy • ↓ coronary perfusion pressure – delivery of plasminogen activators to thrombus impaired.
- 7. Pressure dependent thrombolysis • Successful thrombolysis with tPA in patients with cardiogenic shock after infusion of dopamine or NE (MAP>100mmHg). • Combine therapy more beneficial than either therapy alone . • Imp. Role in hospitals without revascularization facilities by stabilizing patients and facilitating their transfer to teritiary centers.
- 8. IABP assisted Thrombolysis • Patients in cardiogenic shock – TT had lower in-hospital mortality rates (54% vs 64%), – IABP counterpulsation had lower in-hospital mortality rates (50% vs 72%). • Revascularization influenced in-hospital mortality rates significantly (39% vs 78%).
- 9. recommendations for the use of reperfusion • recommendations in patients with CS are similar to those for most patients with MI and differ principally in the level of evidence. • For patients with ST elevation MI, we recommend revascularization as opposed to fibrinolytic therapy (Grade 1A). This recommendation requires that diagnostic coronary angiography be performed within 90 minutes of initial hospital presentation. • For those patients who cannot undergo timely PCI , we recommend fibrinolytic therapy rather than no immediate reperfusion (Grade 1B). • For patients with one or two vessel disease who do not have mechanical complications, we recommend (PCI) of the infarct related artery as opposed to CABG (Grade 1B).
- 10. • For patients with three vessel disease or left main disease who do not have mechanical complications (such as acute mitral regurgitation or rupture of the ventricular septal or free walls), we suggest immediate PCI as opposed to CABG (Grade 2C) • For patients with mechanical complications, we recommended immediate CABG and attempt at repair of the mechanical defect as opposed to PCI (Grade 1B). • For patients with non-ST elevation MI, we recommend that revascularization be performed as soon as possible as opposed to either fibrinolytic therapy or no reperfusion (Grade 1B).
- 11. THANK YOU FOR YOUR ATTENTION !