CARDIOGENIC SHOCK
SHOCK
Shock is a serious life threatening medical
emergency and one of the most common causes of
death for critically ill patients.
Definition
Shock is defined as inadequate tissue perfusion can
be caused by various disease that result in decreased
oxygenation at cellular level.
Stages of Shock
Initial stage
Compensatory stage
Progressive stage
Irreversible stage
Classification
Hypovolemic Shock
Cardiogenic Shock
Distributive Shock
Septic Shock
Anaphylactic shock
Neurogenic shock
CARDIOGENIC SHOCK
DEFINITION
It is the failure of heart to pump blood adequately to
meet the oxygenation needs of body.
ETIOLOGY
Acute MI
Severe hypoxia
Cardiomyopathy
Pericardial tamponade
Acidosis
Dysrhythmia
Trauma
Structural abnormalities
Myocardial Ischemia
Myocarditis
Endocarditis
Drug overdose
CLASSIFICATION
CORONARY : It occurs when significant amount of
left ventricular myocardium has been damaged.
eg: MI
NON CORONARY : mainly due to stress to
myocardium.
eg: hypoglycemia,tension pneumothorax
RISK FACTORS
Old age
History of heart failure
Coronary artery disease
DM or HTN
Existing cardiac diseases
Obesity
CLINICAL FEATURES
Clammy skin
Decreased blood pressure
Tachycardia
Oliguria
Cyanosis
Mental confusion
Chest pain
Other symptoms are:
Rapid breathing
Shortness of breath
Loss of consciousness
Weak pulse
Sweating
Pale skin
Cyanosis
DIAGNOSIS
Physical examination
History collection
Chest X-ray
Cardiac enzyme test (CPK-MB)
ABG,LFT, RFT
Electrocardiogram
Echocardiogram
Cardiac catheterization
PREVENTION
Quit smoking and alcohol
Maintain a healthy weight
Eat less cholestrol
Exercise
Less sugar
MANAGEMENT
It includes:
MEDICAL MANAGEMENT
SURGICAL MANAGEMENT
NURSING MANAGEMENT
MEDICAL MANAGEMENT
The first line treatment is as follows;
Supplying supplemental oxygen.
Controlling chest pain
Selected fluid support
Vasoactive medications
Vasodilators : Nitrates
Beta-blockers : propanolol
Calcium channel blockers : Nifedipine
Thrombolytic drugs : streptokinase
Antiplatelets
Vasopressors
Ionotropes
Diuretics
Diuretics: cardiogenic shock is one of the two types of shock
that doesn’t have a decrease in blood volume (the other is
neurogenic shock).
Patients with cardiogenic shock have a backup of fluid in the
lungs from an injured heart that is failing to pump blood
forward.
Diuretics (ex: furosemide….watch potassium level “
hypokalemia“….normal level is 3.5-5 mEq/L) will help
remove extra fluid volume via the kidneys. This will decrease
the preload (amount ventricles stretch at the end of diastole),
which will help the relieve the workload of the heart. However,
watch the fluid status of the patient, renal function, and for
worsening hypotension.
Vasopressors: causes constriction of vessels and increases preload
(venous return) and cardiac output
Norepinephrine (vasoconstrictor) sometimes used over dopamine because
it doesn’t cause tachydysrhythmias: it increases tissue perfusion by
increasing blood pressure
Vasopressors that create a positive inotropic effect: increases the
strength of the heart’s contraction (increases contractility) and stroke
volume
Dobutamine (increases contractility and cardiac output BUT can
cause vasodilation due to the way it acts on receptors and may
make hypotension WORSE. If this occurs that patient may be started
on norepinephrine or dopamine.
Dopamine (increase contractility, causes vasoconstriction: increases
blood pressure and MAP (want >60 mmHg), but watch out for
tachydysrhythmias)
Vasodilators: decreases preload and afterload:
increases stroke volume because it decreases the
afterload, so it’s easier for the heart to pump blood
forward so cardiac output increases. The workload
on the heart decreases by dilating the coronary
arteries….causes hypotension and may not be used if
the patient is severely hypotensive (monitor blood
pressure very closely). Ex: Nitroglycerin or
Sodium Nitroprusside
SURGICAL MANAGEMENT
CABG
IABP
TRANSVENOUS PACING
PERCUTANEOUS VENTRICULAR ASSIST DEVICE
EXTRACORPOREAL MEMBRANE OXYGENATION
LEFT VENTRICULAR ASSIST
DEVICE
NURSING MANAGEMENT
Nursing assesment :
Vital signs – Asses the patients vital signs especially
blood pressure.
Fluids – Iv fluids and medications should be
administered safely.
Patients receiving thrombolytic therapy must be
monitored for bleeding.
Neurologic assesment to asses for potential
complications of cerebral hemorrhage asso with
therapy.
Monitor urine output, BUN,creatinine levels.
NURSING DIAGNOSIS
Decreased cardiac output related to impaired
contractility due to heart muscle damage.
Impaired gas exchange related to pulmonary
congestion due to elevated left ventricular pressure.
Acute pain related to disease condition as evidenced
by patient verbalization.
Impaired physical mobilization related to weakness
as evidenced by loss of activity.
