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Cardiogenic Shok

Cardiogenic Shok. Some Notes. Develops in 10% to 20% of patients hospitalized AMI Mortality of such patients approximately 80% or higher Very few patients develop shock immediately after AMI About half of the patients develop shock within 24h. Pathology. Clinical signs.

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Cardiogenic Shok

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  1. Cardiogenic Shok

  2. Some Notes • Develops in 10% to 20% of patients hospitalized AMI • Mortality of such patients approximately 80% or higher • Very few patients develop shock immediately after AMI • About half of the patients develop shock within 24h

  3. Pathology

  4. Clinical signs • ECG shows the pattern of AMI or acute coronary insufficiency • The SBP < 80 mm Hg * • Pulse rate is 100 per min or faster** • The urinary output is low, 30 ml or less per hour • There are clinical signs of peripheral circulatory collapse

  5. Differential diagnosis • Massive pulmonary embolism • Acute dissecting aneurism of the aorta • Acute cardiac tamponade • Acute hemorrhage • Cerebrovascular thrombosis • Diabetic acidosis • Acute pancreatitis • Acute adrenal insufficiency

  6. Starlings law of the heart The ability of the heart to increase its output in response to an increase in venouse return represents a positive feedback in which altered blood flow to the heart leads to a corresponding change in blood flow leaving the heart.

  7. Emergency treatment • The first priority in treating cardiogenic shock is to expand the circulating blood volume with IV fluids , using the PWP or CVP as a basic guide

  8. Position the patient* Make certain that there is an adequate airway** Maintain adequate oxygenation*** Start an IV infusion of D5W,using a regular drip bulb at a minimal flow rate Insert a Swan – Ganz catheter into the PA Draw blood for the tests Initial treatment

  9. Initial treatment • Insert a Foley catheter into the urinary bladder to obtain accurate measurements of urinary output* • Monitor the patient continuously** • Relieve pain*** • Relieve agitation**** • Take portable X – ray films of the chest

  10. Definitive treatment • Correction of hypovolemia • Treatment of arrhythmias • Treatment of hypotension • Treatment of metabolic acidosis • Treatment of electrolyte disturbances • Mechanical circulatory assist

  11. Correction of hypovolemia • PWP less than 15 mm Hg • PWP remain stable .16 mm Hg • Initial PWP is between 15 – 18 mm Hg • PWP is 20 mmHg or higher* • Rise in PWP to 16 mm Hg or higher • PWP is low approximately 5 mm Hg • Pulmonary edema**

  12. Schematic guide • Group 1 Low PWP without PE - IV fluids indicated • Group 2 Low PWP with PE - IV fluids indicated • Grout 3 High PWP without PE - Vasodilatators, MCD • Group 4 High PWP with PE - Treatment as G3

  13. Eugene Yevstratov MD Phone: 0054111540682712 (ARG) Private: 0030372236344 / 0030372231698(UKr) Fax: 001 775 796 2780 (USA) Email: ostlandfox@yahoo.de / ostlandfox@medscape.com Link: http://myprofile.cos.com/eugenefox

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