Cardiogenic Shock is defined as an inadequate tissue perfusion because of decreased cardiac output despite an adequate intravascular volume. For example, your body has adequate fluid volume but the body’s pump is failing (a.k.a the heart). THE MOST COMMON CAUSE OF CARDIOGENIC SHOCK IS MYOCARDIAL INFARCTION (SPECIFICALLY THE LEFT VENTRICULAR ANTERIOR WALL). The left anterior descending artery is in this area and is also known as widow-maker if the artery become occluded.
WHAT CAUSES CARDIOGENIC SHOCK?
Myocardial Infarction, Ischemia (MOST COMMON CAUSE)
Sustained Cardiac Dysrhythmias
Acute Valvular Dysfunction
Blunt Cardiac Trauma
MYOCARDIAL INFARCTION MANIFESTATIONS
Cardiac Related Chest Pain
Pale, Cool, Clammy Skin
Tachypnea, Crackles, Pulmonary Edema
Altered Mental Status
Minimal Urine Output
CARDIOGENIC SHOCK ASSESSMENT
Start by assessing Airway, Breathing, and Circulation (ABC)
With any form of shock: ALWAYS DETERMINE THE CAUSE OF CARDIOGENIC SHOCK
Lab Work: CBC, Platelet Count, Liver Function Tests, Renal Function Tests, Lactate Levels
CARDIOGENIC SHOCK INTERVENTION
If Cardiogenic Shock is caused by pulmonary edema in the lung interstitium, Airway management with positive end-expiratory pressure (PEEP) mechanical ventilation.
Decrease preload by decreasing venous return to the heart
Semi-Fowler or Fowler Position
Increase cardiac contractility
Dobutamine (positive inotropes)
Intra-aortic balloon pump (IABP)
Decrease afterload by decreasing the resistance the heart must pump against