Understanding Cardiogenic Shock CEN Review 2018

What is Cardiogenic Shock?

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
End-Stage Cardiomyopathy

MYOCARDIAL INFARCTION MANIFESTATIONS

Cardiac Related Chest Pain
Pale, Cool, Clammy Skin
Tachypnea, Crackles, Pulmonary Edema
Tachycardia, Tachydysrhytmias
Altered Mental Status
Hypotension
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
Electrocardiogram
Chest X-Ray
ABG
Echocardiogram
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
- Nitroglycerin
- Diuretics
- Morphine
Increase cardiac contractility
- Dobutamine (positive inotropes)
- Intra-aortic balloon pump (IABP)
Decrease afterload by decreasing the resistance the heart must pump against
- Nitroglycerin
- Nitroprusside
- Antihypertensives
Cardiac Catheterization
Angioplasty
Treat dysrhythmias