Cardiogenic shock chest x ray: Difference between revisions

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{{cardiogenic shock}}
{{cardiogenic shock}}
{{CMG}}; {{AE}} {{JS}}
{{CMG}}; {{AE}} {{JS}} {{sali}}


==Overview==
==Overview==
Attending to the catastrophic [[outcome]] of cardiogenic shock in a very short time span, its [[diagnosis]] must be reached as early as possible in order for proper [[therapy]] to be started. This period until [[diagnosis]] and [[therapy|treatment]] initiation is particularly important in the case of cardiogenic shock since the [[mortality rate]] of this condition complicating acute-[[MI]] is very high, along with the fact that the ability to revert the damage caused, through [[reperfusion]] techniques, declines considerably with [[diagnostic]] delays. Therefore and due to the unstable state of these patients, the [[diagnostic]] evaluations are usually performed as supportive measures are initiated. The [[diagnostic]] measures should start with the proper [[medical history|history]] and [[physical examination]], including [[blood pressure]] measurement, followed by an [[EKG]], [[echocardiography]], [[chest x-ray]] and collection of [[blood]] samples for evaluation. An [[ECG|electrocardiogram]] may be useful in distinguishing cardiogenic shock from other types of [[shock]], such as [[septic shock]] or [[neurogenic shock]]. The [[chest x-ray]] is an important [[diagnostic]] image tool that in patients with [[left ventricular failure]] may show: [[pulmonary edema]], [[pulmonary]] [[vascular]] redistribution, enlarged hila, kerley's B lines and bilateral [[pleural effusions]]. The physician should keep in mind the common features of [[shock]], irrespective of the type of [[shock]], in order to avoid delays in the [[diagnosis]]. Although not all [[shock]] patients present in the same way, these features include: abnormal [[mental status]], [[cool extremities]], [[clammy skin]], manifestations of [[hypoperfusion]], such as [[hypotension]] and [[oliguria]], as well as evidence of [[metabolic acidosis]] on the [[blood]] results.<ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref>
The [[chest x ray]] will show [[pulmonary edema]], [[pulmonary]] [[vascular]] redistribution, enlarged [[hila]], [[kerley's B lines]], and bilateral [[pleural effusions]] in patients with [[left ventricular failure]].  In contrast, a [[pneumonia]] may be present in the patient with [[septic shock]].[[Chest x-ray]] provides information on cardiac size and pulmonary congestion and may suggest alternative pathogeneses such as aortic dissection, pericardial effusion, pneumothorax, [[esophageal]] [[perforation]], or [[pulmonary embolism]]. The test enables clinicians to confirm the position of the [[endotracheal tube]] and the position of supportive devices, including [[temporary pacing wires]].


==Chest X-ray==
==Chest X-ray==
*The heart may be enlarged ([[cardiomegaly]]) in the patient with [[tamponade]].  A [[widened mediastinum]] may be present in the patient with [[aortic dissection]].
Although not an ideal method to [[diagnose]] cardiogenic shock, the [[chest x-ray]] may provide important information such as:<ref>{{cite book | last = Parrillo | first = Joseph | title = Critical care medicine principles of diagnosis and management in the adult | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2013 | isbn = 0323089291 }}</ref><ref name="ReynoldsHochman2008">{{cite journal|last1=Reynolds|first1=H. R.|last2=Hochman|first2=J. S.|title=Cardiogenic Shock: Current Concepts and Improving Outcomes|journal=Circulation|volume=117|issue=5|year=2008|pages=686–697|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.613596}}</ref>
 
*Rulling out conditions like [[pneumonia]], which may be the cause of other types of [[shock]]
*The chest x-ray may also be useful in excluding a [[tension pneumothorax]] that may be associated with [[hypotension]].
*Identification of [[cardiomegaly]] in the patient with [[tamponade]]
 
*Identification of a [[widened mediastinum]], which may be present in the patient with [[aortic dissection]]
*Not a reliable predictor of [[pulmonary capillary wedge pressure]].<ref name="ReynoldsHochman2008">{{cite journal|last1=Reynolds|first1=H. R.|last2=Hochman|first2=J. S.|title=Cardiogenic Shock: Current Concepts and Improving Outcomes|journal=Circulation|volume=117|issue=5|year=2008|pages=686–697|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.613596}}</ref>
*Exclusion of a [[tension pneumothorax]] possibly associated with [[hypotension]]
*Confirmation of [[pulmonary edema]], consequence of cardiogenic shock
*Diagnosis of [[tension pneumothorax]]
*However, it is not a reliable predictor of [[pulmonary capillary wedge pressure]]


==References==
==References==

Latest revision as of 18:18, 8 January 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2] Syed Musadiq Ali M.B.B.S.[3]

Overview

The chest x ray will show pulmonary edema, pulmonary vascular redistribution, enlarged hila, kerley's B lines, and bilateral pleural effusions in patients with left ventricular failure. In contrast, a pneumonia may be present in the patient with septic shock.Chest x-ray provides information on cardiac size and pulmonary congestion and may suggest alternative pathogeneses such as aortic dissection, pericardial effusion, pneumothorax, esophageal perforation, or pulmonary embolism. The test enables clinicians to confirm the position of the endotracheal tube and the position of supportive devices, including temporary pacing wires.

Chest X-ray

Although not an ideal method to diagnose cardiogenic shock, the chest x-ray may provide important information such as:[1][2]

References

  1. Parrillo, Joseph (2013). Critical care medicine principles of diagnosis and management in the adult. Philadelphia, PA: Elsevier/Saunders. ISBN 0323089291.
  2. Reynolds, H. R.; Hochman, J. S. (2008). "Cardiogenic Shock: Current Concepts and Improving Outcomes". Circulation. 117 (5): 686–697. doi:10.1161/CIRCULATIONAHA.106.613596. ISSN 0009-7322.


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