CARDIOGENIC

SHOCK
Presented By:-LOVESH SHARMA
B.Sc (N) 4th year
 INTRODUCTION
Cardiogenic shock is rare. It's often
deadly if not treated immediately. When
treated immediately, about half the people
who develop the condition survive.
 DEFINITION
Cardiogenic shock is a life-threatening
condition in which your heart suddenly
can't pump enough blood to meet your body
needs. The condition is most often caused by a
severe heart attack, but not everyone who has
a heart attack has cardiogenic shock.
 STAGES
At risk (A): Heart disease, such as heart attack or
heart failure, but no signs of shock.

Beginning (B): Low blood pressure or heart rate.

Classic (C): Need for medicine or devices to help get

blood to organs.

Deteriorating (D): Not responding to medicine or

devices and getting worse.

Extremis (E): Cardiac arrest that needs CPR,

ventilator and defibrillator.
CLASSIFICATION
• The causes of cardiogenic shock are known as
either coronary or non-coronary.
• Coronary. Coronary cardiogenic shock is
more common than non coronary cardiogenic
shock and is seen most often in patients with
acute myocardial infarction.
CONTD…

•Noncoronary. Noncoronary cardiogenic
shock is related to conditions that stress
the myocardium as well as conditions
that result in an ineffective myocardial
function.
 CAUSES
1. In most cases, a lack of oxygen to
your heart, usually from a heart
attack, damages its main pumping
chamber (left ventricle). Without
oxygen-rich blood flowing to that
area of your heart, the heart muscle
can weaken and go into
cardiogenic shock.(MI)
CONTD…
2. Structural Abnormalities

3. Too much fluid or blood

around your heart (
cardiac tamponade).

4. A blood clot that

suddenly blocks a blood
vessel in your lung.
CONTD…
5. A heart valve problem, such as torn muscles
supporting your valve or an artificial valve
not working right.

6. Damage to the septum that divides the left

and right ventricles of your heart.

7. Heart Failure.

8. Injury to your chest.

OTHER POSSIBLE CAUSES OF
CARDIOGENIC SHOCK
INCLUDE:
1. Inflammation of the heart muscle (myocarditis)

2. Infection of the endocardium (endocarditis)

3. Infection of the pericardium(pericarditis)

4. Weakened heart from any cause

CONTD…

1. Drug overdoses or poisoning with

substances that can affect your heart's
pumping ability

2. Smoking

3. Alcohol Abuse.
 Risk factors
If you have a heart
attack, your risk of
developing cardiogenic
shock increases if you:

1. Are older

2. Have a history of
heart failure or heart
attack
 CONTD…

3. Have blockages
(coronary artery disease)
in your heart's main
arteries

4. Have diabetes or high

blood pressure

5. Are female
 SYMPTOMS
• Rapid breathing

• Severe shortness of
breath (Dyspnea)
• Sudden, rapid heartbeat
(tachycardia)
• Loss of consciousness
CONTD…

• Weak pulse

• Low blood pressure

(hypotension)
• Pain or discomfort in
your upper body
and/or down your left
arm.
 CONTD…
• Fainting.

• Feeling very tired.

• Swelling in your belly and

legs.
• Feeling very weak,
lightheaded and/or anxious.
• Poor appetite.
CONTD…

• Sweating

• Pale skin

• Cold hands or feet

• Urinating less than

normal or not at all
• Pain in the upper
abdomen, throat or jaw.
Diagnostic Evaluation
•Blood pressure
measurement. People in
shock have very low
blood pressure.
CONTD…

• Electrocardiogram (ECG or EKG). This

quick, noninvasive test records the electrical
activity of your heart using electrodes
attached to your skin. If you have damaged
heart muscle or fluid buildup around your
heart, the heart won't send electrical signals
normally.
CONTD..

•Blood tests. An
arterial blood gas
test might be done to
measure oxygen in
your blood.
CONTD…

•Echocardiogram. Sound waves produce

an image of your heart. This test can help
identify damage from a heart attack.
CONTD..

•Chest X-ray. A chest X-

ray shows the size and
shape of your heart and
whether there's fluid in
your lungs.
CONTD…

• Cardiac catheterization (angiogram). This

test can reveal blocked or narrowed arteries. A
doctor inserts a long, thin tube (catheter)
through an artery in your leg or wrist and
guides it to your heart. Dye flows through the
catheter, making your arteries more easily seen
on X-ray.
 MANAGEMENT
•Emergency life support
 CONTD…

•Most people who have cardiogenic shock need

extra oxygen. If necessary, you'll be connected
to a breathing machine (ventilator).
•Cardiogenic shock treatment focuses on
reducing the damage from lack of oxygen to
your heart muscle and other organs.
PHARMACOLOG
ICAL
MANAGEMENT
 PHARMACOLOGICAL
MANAGEMENT
Medications to treat cardiogenic shock are
given to increase your heart's pumping ability
and reduce the risk of blood clots.
• Vasopressors. These medications are used to
treat low blood pressure. They include
dopamine, epinephrine, norepinephrine and
others.
CONTD…
•Aspirin. Aspirin is usually given
immediately to reduce blood clotting and
keep blood moving through a narrowed
artery.
•Antiplatelet medication. These
medications include clopidogrel,
tirofiban and eptifibatide.
CONTD…
• Other blood-thinning medications. You'll
likely be given other medications, such as
heparin, to make your blood less likely to
form clots. IV or injectable heparin usually is
given during the first few days after a heart
attack.
• Opiate. A substance used to treat pain or
cause sleep. Medications include morphine.
CONTD…

•Inotropic agents. These medications,

which help improve the pumping function

of the heart, may be given until other

treatments start to work. They include

dobutamine, dopamine and milrinone.

SURGICAL
MANAGEMENT
 SURGICAL
MANAGEMENT
• Angioplasty and stenting. If a blockage is found
during a cardiac catheterization, your doctor can
insert a long, thin tube (catheter) equipped with a
special balloon through an artery, usually in your
leg, to a blocked artery in your heart. Once in
position, the balloon is briefly inflated to open the
blockage.
CONTD..

•A metal mesh stent might be inserted

into the artery to keep it open over time.
In most cases, you doctor will place a
stent coated with a slow-releasing
medication to help keep your artery
open.
CONTD…

• Extracorporeal membrane oxygenation

(ECMO). ECMO helps improve blood flow
and supplies oxygen to the body. Blood is
pumped outside of your body to a heart-lung
machine that removes carbon dioxide and
sends oxygen-filled blood back to tissues in
the body.
CONTD…
• Coronary artery bypass surgery. This surgery
uses a healthy blood vessel in your leg, arm or
chest to create a new pathway for blood so it can
flow around a blocked or narrowed artery.
Occasionally, bypass surgery is done as an
emergency treatment.
CONTD…

•Surgery to repair an injury to your

heart. Sometimes an injury, such as a
tear in one of your heart's chambers or a
damaged heart valve, can cause
cardiogenic shock. Surgery might
correct the problem.
CONTD…
• Ventricular assist device (VAD). A mechanical
device can be implanted into the abdomen and
attached to the heart to help it pump.
A VAD might extend and improve the lives of
some people with end-stage heart failure who
are waiting for new hearts or aren't able to have
a heart transplant.
CONTD…

•Heart transplant. If your heart is so

damaged that no other treatments work,
a heart transplant may be a last resort.
NURSING MANAGEMENT
NURSING
MANAGEMENT
• Enhance safety and comfort. Administering
of medication to relieve chest pain,
preventing infection at the multiple arterial
and venous line insertion sites, protecting the
skin, and monitoring respiratory and renal
functions help in safeguarding and enhancing
the comfort of the patient.
CONTD…

•Fluids. IV infusions must be observed

closely because tissue necrosis and
sloughing may occur if vasopressor
medications infiltrate the tissues, and it
is also necessary to monitor the 
intake and output.
CONTD…

•Intra-aortic balloon counter

pulsation. The nurse makes ongoing
timing adjustments of the balloon pump
to maximize its effectiveness by
synchronizing it with the cardiac cycle.
CONTD…

•Arterial blood gas. Monitor ABG values to

measure oxygenation and detect acidosis
from poor tissue perfusion.
CONTD…

• Positioning If the patient is on the IABP,

reposition him often and perform passive
range of motion exercises to prevent skin
breakdown, but don’t flex the patient’s
“ballooned” leg at the hip because this may
displace or fracture the catheter.
CONTD…
• Hemodynamic status. Arterial lines and ECG
monitoring equipment must be well maintained
and functioning; changes in hemodynamic,
cardiac, and pulmonary status and laboratory
values are documented and reported; and
adventitious breath sounds, changes in cardiac
rhythm, and other abnormal physical assessment
findings are reported immediately.
CONTD…

•Prevent recurrence. Identifying at-risk

patients early, promoting adequate
oxygenation of the heart muscle, and
decreasing cardiac workload can
prevent cardiogenic shock.
COMPLICATIONS OF
THE TREATMENT
• Abnormal heart rhythm.

• Bleeding.

• Kidney injury.

• Injured blood vessel.

• Chest pain.

• Stroke.
COMPLICATIONS
• If not treated immediately, cardiogenic shock
can lead to death. Another serious
complication is damage to your liver, kidneys
or other organs from lack of oxygen, which
can be permanent
PREVENTIONS
•Maintain a healthy
weight. 
•Eat less cholesterol and
saturated fat. 
•Limit alcohol.
CONTD..
• Use less salt. Too much
salt (sodium) leads to
fluid buildup in the body,
which can strain the
heart.

• Exercise regularly. 

• Don't smoke, and avoid

secondhand smoke.