Cardiogenic shock chest x ray
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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]
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 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 history and physical examination, including blood pressure measurement, followed by an EKG, echocardiography, chest x-ray and collection of blood samples for evaluation. An 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 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.[1]
Chest X-ray
Although not an ideal method to diagnose cardiogenic shock, the chest x-ray may provide important information such as:[2][3]
- Rulling out conditions like pneumonia, which may be the cause of other types of shock
- Identification of cardiomegaly in the patient with tamponade
- Identification of a widened mediastinum, which may be present in the patient with aortic dissection
- 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
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ Parrillo, Joseph (2013). Critical care medicine principles of diagnosis and management in the adult. Philadelphia, PA: Elsevier/Saunders. ISBN 0323089291.
- ↑ 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.