cardiogenic shock

2. Cardiogenic shock is defind as heart inability to
contract & pump blood efficiently due to
inadequate supply of o2 & nutrient to the heart.

3. Old age
A history of heart attack
Coronary artery disease
Hypertension
DM
Obesity
Atherosclerosis

4. Due to intrinsic heart problem:-
MI
Dysrhythmia
Vulvular heart disease
Cardiomyopathy
Due to other cause:-
Pulmonary embolism
Pericardial temponade
Myocardial suppression due to bacteraemia
Suppress myocardial contractility due to
Hyperkalemia or Hypokalemia.

5. DUE TO ETIOLOGY
IMPAIRED PUMPING ABILITY OF THE LEFT VENTRICLE
DECREASE STROKE VOLUME INADEQUATE SYSTOLIC EMPTYING
DECREASE CARDIAC OUTPU ELEVATED LEFT VENTRICLE FILLING
PRESSURE
DECREASE BLOOD PRESSURE INCREASED LEFT ATRIAL
PRESSURE
DECREASE TISSUE PERFUSSION INCREASE PULMONARY
VENOUS PRESSURE
LACTIC ACIDOSIS INCREASE PULMONARY CAPILLARY
PRESSURE
PULMONARY INTERSTITIAL EDEMA ,INTRA
ALVEOLAR EDEMA.

6. Chest pain
Nausea & vomiting
Dyspnoea
Confusion
Disorientation
Mental lethargy
Palpitation
Fainting
Cold clammy skin
Dysrhythmia
Tachycardia/ Bradycardia
Distended jugular vein
Oligurea urine output less than 30ml/hr

7. Brain damage
Kidney damage
Liver damage
Multiple organ failure
Coma
Death

8. History collection:-
Physical examination:-
Blood pressure measurement
EEG,Chest x ray
Echocardiography
Coronary Angiography
ABG analysis, CBC
Brain natriuretic peptide:- Brain natriuretic
peptide (BNP) is a peptide hormone that is released in
response to volume expansion and the increased wall
stress of cardiac myocytes. BNP helps to promote diuresis,
natriuresis, vasodilation of the systemic and pulmonary
vasculature, and reduction of circulating levels of
endothelin and aldosterone

9. GOAL:- Treat the shock first, treat underlying cause
Emergency life support:-
Provide patient extra oxygen to breath so that more
oxygen reach the lungs, heart & other body part.
Provide fluid as well as blood product to maintain vital
organ perfusion.
Arrhythmia treat with shock therapy.
Medication:-
Provide medication to increase the force of contraction of
heart.
Provide medication to increase blood pressure & heart
function

10. Anticoagulant to reduce the risk of blood cloting
Digoxin
Diuretics
Dopamine & dobutamin
Intra aortic balloon pump:- It is a device which help to
heart pump & improve blood flow.
Angioplasty & stent:- To open the narrowed or blocked
artery.
Surgery:-
Coronary artery bypass grafting:- In this surgery arteries or
vein from other part of the body are used to by pass
narrowed coronary artery.
Surgeries to repaire heart:- Any tear & injury to the heart
such as tear in one of heart chamber or a damage heart
valve should be repair to correct the problem.
Pace maker:- To pump heart artificially,Heart transplant.

11. Decreased cardiac output related to impaired
contractility due to hypertrophy cardiac muscle.
Interventions:-
ECG monitoring to detect dysrhythmia
Monitoring BP & mean arterial pressure every 30
min.
Measure & record urine output in every hour
from indwelling catheter & fluid intake.
Obtain daily weight.

12. Improving oxygenation:-
Monitor respiratory rate & rhythem every hour.
Auscultate lungs field for abnormal sound every hour.
Monitor arterial blood gas level
Administer o2 therapy to increase oxygen tension &
improve hypoxia
Elevate head of the bed 20 to 30 degree to facilitate
lungs expansion.
Maintain tissue perfusion:-
Perform a neurologic state every hour, using the GCS.
Obtain blood urea nitrogen & Creatinin blood level to
evaluate renal function
Auscultate for bowel sound every 2 hour
Assess character, rate, rhythm & quality of arterial
pulses every 2 hours.