Cardiogenic Shock

Tuesday, January 29, 2019 11:45 PM

• Shock of diminished cardiac output that severely

impairs cardiac perfusion, "pump failure"
• Reflects severe left-sided heart failure

Patho:
1. Inability to contract: when myocardium cant contract
sufficiently to maintain adequate cardiac output,
stroke volume decreases and the heart cant eject
adequate volume of blood with each contraction
2. Pulmonary congestion: the blood backs up behind the
weakened left ventricle, increasing preload and
causing pulmonary congestion
3. Compensation: to compensate for the drop in stroke
volume, the heart rate increases in an attempt to
maintain cardiac output
4. Diminished stroke volume: as a result of diminished
stroke volume, coronary artery perfusion and
collateral blood flow is decreased
5. Increased workload: all of these mechanisms increase
the hearts workload and enhance left-sided heart
failure
6. End result: the result in myocardial hypoxia,
decreased cardiac output, and a triggering of
compensatory mechanisms to prevent decompensation and
death
Causes:
• MI: regardless of the underlying cause, left
ventricles dysfunction set in motion a series of
compensatory mechanisms that attempt to increase
cardiac output but later on leads to deterioration
• Myocardial Ischemia: compensatory mechanisms may
stabilize the pt but later on would cause
deterioration with the rising demands of oxygen of the
already compromised myocardium
• End-stage cardiomyopathy: the inability of the heart
to pump enough blood for the systems causes
cardiogenic shock
Diagnostic Findings:
• ABGs: may show metabolic acidosis and hypoxia
• Enzyme levels: lactic dehydrogenase and creatine
kinase

Med Management:
• Oxygen: prescribed to minimize damage to muscles and
organs
• Angioplasty and stenting: catheter inserted into
blocked artery to open it up
• Pain control: IV morphine
• Hemodynamic monitoring
• Fluid Therapy

Pharmacologic Therapy:
• IV dopamine: a vasopressor, increases cardiac output,
BP and renal blood flow
• IV dobutamine: inotropic agent that increases
myocardial contractility
• Norepinephrine: potent vasoconstrictor that is taken
when necessary
 • IV dopamine: a vasopressor, increases cardiac output,
BP and renal blood flow
• IV dobutamine: inotropic agent that increases
myocardial contractility
• Norepinephrine: potent vasoconstrictor that is taken
when necessary
• If MI: ASA, Heparin

Surgical Management:
• Intra-aortic balloon pump (IABP): mechanical-assist
device that attempts to improve the coronary artery
perfusion and decrease cardiac workload through an
inflatable balloon pump which is percutaneously or
surgically inserted through the femoral artery into
the descending thoracic aorta