Cardiogenic Cardiogenic ShokShok

Some NotesSome NotesDevelops 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

PathologyPathology

Clinical signsClinical 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

Differential diagnosisDifferential diagnosisMassive pulmonary embolism

Acute dissecting aneurism of the aorta

Acute cardiac tamponade

Acute hemorrhage

Cerebrovascular thrombosis

Diabetic acidosis

Acute pancreatitis

Acute adrenal insufficiency

Starlings law of the Starlings law of the heartheart

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.

Emergency treatmentEmergency 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

Initial treatmentInitial treatment1. Position the patient*

2. Make certain that there is an adequate airway**

3. Maintain adequate oxygenation***

4. Start an IV infusion of D5W,using a regular drip bulb at a minimal flow rate

5. Insert a Swan – Ganz catheter into the PA

6. Draw blood for the tests

1. Insert a Foley catheter into the urinary bladder to obtain accurate measurements of urinary output*

2. Monitor the patient continuously**

3. Relieve pain***

4. Relieve agitation****

5. Take portable X – ray films of the chest

Initial treatmentInitial treatment

Definitive treatmentDefinitive treatment

Correction of hypovolemia

Treatment of arrhythmias

Treatment of hypotension

Treatment of metabolic acidosis

Treatment of electrolyte disturbances

Mechanical circulatory assist

Correction of Correction of hypovolemiahypovolemia

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**

Schematic guideSchematic guide

Group 1Group 1 Low PWP without PE - IV fluids indicated

Group 2Group 2 Low PWP with PE - IV fluids indicated

Grout 3Grout 3 High PWP without PE - Vasodilatators, MCD

Group 4Group 4 High PWP with PE - Treatment as G3

Eugene Yevstratov Eugene Yevstratov MDMD

Phone: 0054111540682712 (ARG)Private: 0030372236344 / 0030372231698(UKr)Fax: 001 775 796 2780 (USA)Email: ostlandfox@yahoo.de / ostlandfox@medscape.com

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