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Cardiogenic Shock

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by

Jennifer Kang

on 30 June 2014

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Transcript of Cardiogenic Shock

Cardiogenic Shock
Definition
• A dysfunction of the pumping action of the heart causing an insufficient volume of oxygen-rich blood to perfuse the body's tissues
• Characterized by a SBP < 90 mmHg or a drop in the mean arterial pressure > 30 mmHg and low urine output (< 0.5 mL/kg/hr)
Causes
Systolic Dysfunction
Inability of the heart to pump blood forward
Eg. Myocardial Infarction (major cause), cardiomyopathies, blunt cardiac injury, severe systemic or pulmonary hypertension, myocardial depression
Diastolic Dysfunction
Inadequate filling of blood in the ventricles
Eg. Cardiac tamponade, cardiomyopathy
Dysrhythmias
Irregular conduction of the heart
Structural Factors
Valvular abnormality (i.e. stenosis, regurgitation)
Eg. Ventricular septal rupture, tension pneumothorax
Risk Factors
• Older age ( > 65 years)
• History of MI, CVA
• Anterior Wall MI
• Coronary artery disease
• Hypertension
• Diabetes Mellitus
• High Cholesterol and Sodium Diet

http://www.nhlbi.nih.gov/health/health-topics/topics/shock/
Prevention
• Exercise
• Maintain Healthy
Weight
• Balanced Diet
• Control BP
• Managing Stress
• No Smoking
http://www.mayoclinic.org/diseases-conditions/cardiogenic-shock/basics/prevention/con-20034247
Diagnostics
Electrocardiogram (ECG)
Angiogram
Chest X-Ray
Echocardiogram
Pulmonary Artery Catheterization
Blood Tests/Arterial Blood Gases
Cardiac Enzyme Test (↑ levels)
http://www.nhlbi.nih.gov/health/health-topics/topics/shock/diagnosis.html
↑Blood glucose, ↑BUN, ↑Lactate, ↑Urine Specific Gravity, ↓HcT, ↓HgB
ALT, AST, Cr, CK , LDH, Mb, cTNT
http://my.clevelandclinic.org/heart/diagnostics-testing/laboratory-tests/enzyme-protein-blood-tests.aspx
Clinical Manifestations
Central Nervous System
↓ Cerebral Perfusion
Loss of Consciousness
Agitation
Confusion
Anxiety
Cardiovascular
↑ HR; Tachycardia
↑ Vascular Resistance
Hypotension
↓ Cardiac Output
Narrow Pulse Pressure
S₃ Summation Gallop
On Auscultation Over Left Apex
↑ Preload in Left Ventricle
↑ Pulmonary Artery Pressure
↑Pulmonary capillary occlusion pressure
> 15 mmHg; Normal <12 mmHg
JVD
Gastrointestinal
↓ Bowel Sounds
Nausea
Vomiting
Renal
↑Blood Urea Nitrogen Levels
↑Na+ and H2O Retention
↓Renal Blood Flow
↓Urine Output
↓renal blood flow leads to accumulation of BUN before reaching kidneys
Hepatic
Hematemesis
Rectal Bleeding
Change in LOC
Pain in RUQ
Jaundice
Liver Failure
Due to Under Perfusion
http://www.localhealth.com/article/liver-failure/symptoms
Respiratory
Coarse Crackles
Wheezes
Tachypnea
Cyanosis
ABG First SHOW
Respiratory Alkalosis
Hyperventilation
ABG in Later Stages with Pulmonary Edema
Respiratory Acidosis
Hypoxemia
Pulmonary Edema
Integumentary
Pallor
Diaphoresis
Skin Breakdown
↓Skin Integrity
Cold, Clammy Skin
Due to Peripheral Vasoconstriction
Due to Inadequate Diet and Lack of Mobility
http://nursing.unboundmedicine.com/nursingcentral/ub/view/Diseases-and-Disorders/73546/all/cardiogenic_shock
Collaborative Care
Support Respiratory
Function

• Prevent Ischemia
• Oxygen Administration
• Support Breathing if Respiratory Failure is Present
• Positive Pressure Ventilation
• Endotracheal Intubation
Restore
Blood Flow

Thrombolytic Therapy
Destroys clots that disrupt
cardiac blood supply
E.g. Streptokinase and TPA
(Tissue Plasminogen Activator)
Angioplasty with Stenting
Opens obstructed
coronary arteries
http://www.mayoclinic.org/diseases-conditions/cardiogenic-shock/basics/treatment/con-20034247
Revascularization
CABG
(Coronary Artery Bypass Grafting)
Sewing veins/arteries in place to allow
blood to bypass obstructed artery
Intra-Aortic Balloon Pump (IABP)
↓Afterload
With inflation of balloon IABP
↑coronary artery perfusion and↓afterload
http://www.medscape.com/viewarticle/587246_6
Ventricular Assistive Device (VAD)
Used with severe cardiogenic shock
in an attempt to save patient's life
↓ Cardiac Workload
• Vasodilators to ↓ afterload and dilat coronary arteries
• E.g. Nitroglycerin, nitroprusside, and hydrazine
• Diuretics to ↓ preload
• E.g. Furosemide and Metolazone
↑ Cardiac Contractility
• Vassopressors to ↑BP
• Dopamine, norepinephrine, and epinepherine
• Inotropic agents to ↑CO
• Dobutamine
Nursing Management
Oxygenation and
• Oxygen administration
• Position the patient to
support effective breathing
Respiratory Function
Maintain
Homeostasis
• Vasopressors
• Antibiotics
• Fluid balance
• Insertion of urinary catheter
• Fluid replacement
Pain
Management
• Analgesic
Assessments
Tissue
Perfusion
• LOC
• Capillary Refill
• Urine Output
Monitor
Lab Findings
• Complete Blood Count (CBC)
• Arterial Blood Gases (ABG)
• Liver Function
• International Normalized Ratio (INR)
• Prothrombin Time (PT)
If IABP
Use
• Monitor limbs for ischemia

General Information
By: Anna Bienert, Jenni Kang, Victoria Kunin & Taylor Smith-Fall
Full transcript