Cardiogenic shock resident survival guide: Difference between revisions
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{{Family tree | | | | | | | | B01 | | | |B01= '''ABCD''' <br> Airway / O2 / 2 wide bore IV access / 12-lead ECG / focused H&P / CXR }} | {{Family tree | | | | | | | | B01 | | | |B01= '''ABCD''' <br> Airway / O2 / 2 wide bore IV access / 12-lead ECG / focused H&P / CXR }} | ||
{{Family tree | | | | |,|-|-|-|+|-|-|-|.| | }} | {{Family tree | | | | |,|-|-|-|+|-|-|-|.| | }} | ||
{{Family tree | | | | C01 | | C02 | | C03 |C01= '''STEMI''' |C02= | {{Family tree | | | | C01 | | C02 | | C03 |C01= ECG: ST Elevation <br> Echo: Wall mation abnormality |C02= ECG: -ve <br> Echo: flow regurgitation or rupture papillea |C03= Mainly clinical diagnosis <br> ECG: -ve } | ||
{{Family tree | | | | |!| | | |!| | | |!| | }} | |||
{{Family tree | | | | C01 | | C02 | | C03 |C01= '''STEMI''' |C02= Acute valvular lesions |C03= Heart failure }} | |||
{{Family tree/end}} | {{Family tree/end}} | ||
Revision as of 17:30, 24 December 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]
Definition
It is a state of end-organ hypoperfusion due cardiac failure leading to hemodynamic changes for 30 mins or more which is not due to hypovolemia or any other rapidly correctable causes:
- SBP < 80 mmHg or MAP < 30 mmHg than baseline
- Cardiac index ( CI ) < 1.8 L.Min-1·M-2 without vasopressors support or CI 2.0 to 2.2 L.Min-1·M-2 with vasopressors support.
- Elevated filling pressures LVEDP > 18 mmHg, RVEDP > 10 mmHg
Causes
Life Threatening Causes
Common Causes
- Cardiogenic shock
- Pump problems: LV failure mainly in anterior wall MI (the most common cause) and cardiomyopathy post-MI.
- Mechanical failure: Ventricular septal rupture, contained free wall rupture, and papillary muscle rupture. Mechanical problems are strongly suspected in non anterior MI. However cardiac tamponade, tension pneumothorax) and aortic stenosis are recently considered as obstructive shock.
- Electrical failure: Most commonly due toVF or VT and AF.
Prognosis
- Cardiogenic shock occurs in 8% of hospitalized STEMI patient with a mortality rate of 50-60% within 30 days.
- The only way to prevent CS is an early reperfusion therapy for MI
Management
{{Family tree | | | | C01 | | C02 | | C03 |C01= ECG: ST Elevation
Echo: Wall mation abnormality |C02= ECG: -ve
Echo: flow regurgitation or rupture papillea |C03= Mainly clinical diagnosis
ECG: -ve }
Shock | |||||||||||||||||||||||||||||
ABCD Airway / O2 / 2 wide bore IV access / 12-lead ECG / focused H&P / CXR | |||||||||||||||||||||||||||||
STEMI | Acute valvular lesions | Heart failure | |||||||||||||||||||||||||||