Difference between revisions of "Cardiogenic shock differential diagnosis"

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(Differential Diagnosis)
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::*When comparing [[hypovolemic shock|hypovolemic]] and [[cardiogenic shock]] (most commonly complicating acute-[[MI]]) some specific clinical [[signs]] of [[shock]] will be similar, however, others will be different, particularly [[signs]] of [[CHF]], such as the presence of distended [[jugular]] and peripheral [[veins]], presence of an [[S3]] sound and [[pulmonary edema]] on the cardiogenic type.
 
::*When comparing [[hypovolemic shock|hypovolemic]] and [[cardiogenic shock]] (most commonly complicating acute-[[MI]]) some specific clinical [[signs]] of [[shock]] will be similar, however, others will be different, particularly [[signs]] of [[CHF]], such as the presence of distended [[jugular]] and peripheral [[veins]], presence of an [[S3]] sound and [[pulmonary edema]] on the cardiogenic type.
 
::*When comparing [[hemodynamic]] data, similarities include: decreased [[cardiac index]], [[stroke volume]] index, [[cardiac output]], mixed [[venous]] [[oxygen saturation]] and increased difference in arteriovenous O<sub>2</sub> saturation and [[SVR]]. Differences to be noted include: decreased [[ventricular]] [[preload]], [[ventricular]] [[diastolic]] volumes and pressures, [[pulmonary wedge pressure]] and [[central venous pressure]].
 
::*When comparing [[hemodynamic]] data, similarities include: decreased [[cardiac index]], [[stroke volume]] index, [[cardiac output]], mixed [[venous]] [[oxygen saturation]] and increased difference in arteriovenous O<sub>2</sub> saturation and [[SVR]]. Differences to be noted include: decreased [[ventricular]] [[preload]], [[ventricular]] [[diastolic]] volumes and pressures, [[pulmonary wedge pressure]] and [[central venous pressure]].
::*When treating hypovolemic shock it's mandatory to rule out cardiogenic cause because part of the treatment for [[hypovolemic shock]], urgent intravascular volume replacement, may further jeopardize the [[cardiac]] condition in the cardiogenic form.
+
::*When treating [[hypovolemic shock]] it's mandatory to rule out [[cardiogenic]] cause because part of the treatment for [[hypovolemic shock]], urgent [[intravascular]] volume replacement, may further jeopardize the [[cardiac]] condition in the cardiogenic form.
  
 
:*'''[[Obstructive shock]]'''
 
:*'''[[Obstructive shock]]'''

Revision as of 17:29, 16 January 2020

Cardiogenic Shock Microchapters

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Overview

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Differentiating Cardiogenic shock from other Diseases

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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

Shock is a clinical syndrome resulting from the hypoperfusion of the tissues. Regardless of the underlying cause, this hypoperfusion leads to the failure to meet tissues' nutritional and oxygen needs, causing cellular dysfunction. The affected tissues lead to the production and release of inflammatory mediators that will further jeopardize perfusion through changes in the vasculature. The results of these changes are organ failure and death if treatment in not timely applied. According to the underlying cause, there will be different types of shock, which will have similar presentations. It is mandatory to determine the underlying cause of the condition so that proper treatment may be started. Cardiogenic shock is a clinical condition, defined as a state of systemic hypoperfusion originated in cardiac failure, in the presence of adequate intravascular volume, typically followed by hypotension, which leads to insufficient ability to meet oxygen and nutrient demands of organs and other peripheral tissues. It may range from mild to severe hypoperfusion and may be defined in terms of hemodynamic parameters, which according to most studies, means a state in which systolic blood pressure is persistently < 90 mm Hg or < 80 mm Hg, for longer than 1 hour, with adequate or elevated left and right ventricular filling pressures that does not respond to isolated fluid administration, is secondary to cardiac failure and occurs with signs of hypoperfusion (oliguria, cool extremities, cyanosis and altered mental status) or a cardiac index of < 2.2 L/min/m² (on inotropic, vasopressor or circulatory device support) or < 1.8-2.2 L/min/m² (off support) and pulmonary artery wedge pressure > 18 mm Hg.

Differential Diagnosis

Depending on the author and the source used there will be different ways of organizing the types of shock. Sometimes it might be difficult to differentiate, from the clinical standpoint, two types of shock since components of each type may combine in a single patient. The clinical presentation of shock is usually the result of a complexity of processes, such as the sympathetic and endocrine responses to hypoperfusion, along with manifestations of organ failure. Patients who present with signs and symptoms of hypoperfusion following a diagnosed or suspected myocardial infarction, are commonly suffering a cardiogenic shock as a complication of the MI. However, other clinical scenarios, not related to acute MI, may present similarly:[1][2]

Classification of shock based on hemodynamic parameters. (CO, cardiac output; CVP; central venous pressure; PAD, pulmonary artery diastolic pressure; PAS, pulmonary artery systolic pressure; RVD, right ventricular diastolic pressure; RVS, right ventricular systolic pressure; SVO2, systemic venous oxygen saturation; SVR, systemic vascular resistance.)[10][11]
Type of Shock Etiology CO SVR PCWP CVP SVO2 RVS RVD PAS PAD
Cardiogenic Acute Ventricular Septal Defect ↓↓ N — ↑ ↑↑ ↑ — ↑↑ N — ↑ N — ↑ N — ↑
Acute Mitral Regurgitation ↓↓ ↑↑ ↑ — ↑↑ N — ↑
Myocardial Dysfunction ↓↓ ↑↑ ↑↑ N — ↑ N — ↑ N — ↑
Right Ventricular Infarction ↓↓ N — ↓ ↑↑ ↓ — ↑ ↓ — ↑ ↓ — ↑
Obstructive Pulmonary Embolism ↓↓ N — ↓ ↑↑ ↓ — ↑ ↓ — ↑ ↓ — ↑
Cardiac Tamponade ↓ — ↓↓ ↑↑ ↑↑ N — ↑ N — ↑ N — ↑
Distributive Septic Shock N — ↑↑ ↓ — ↓↓ N — ↓ N — ↓ ↑ — ↑↑ N — ↓ N — ↓
Anaphylactic Shock N — ↑↑ ↓ — ↓↓ N — ↓ N — ↓ ↑ — ↑↑ N — ↓ N — ↓
Hypovolemic Volume Depletion ↓↓ ↓↓ ↓↓ N — ↓ N — ↓

References

  1. Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
  2. Parrillo, Joseph (2013). Critical care medicine principles of diagnosis and management in the adult. Philadelphia, PA: Elsevier/Saunders. ISBN 0323089291.
  3. Lier H, Bernhard M, Hossfeld B (March 2018). "[Hypovolemic and hemorrhagic shock]". Anaesthesist (in German). 67 (3): 225–244. doi:10.1007/s00101-018-0411-z. PMID 29404656.
  4. Kobayashi L, Costantini TW, Coimbra R (December 2012). "Hypovolemic shock resuscitation". Surg. Clin. North Am. 92 (6): 1403–23. doi:10.1016/j.suc.2012.08.006. PMID 23153876.
  5. "Shock: Shock and Fluid Resuscitation: Merck Manual Professional".
  6. Pich H, Heller AR (May 2015). "[Obstructive shock]". Anaesthesist (in German). 64 (5): 403–19. doi:10.1007/s00101-015-0031-9. PMID 25994928.
  7. Dababneh E, Siddique MS. PMID 28613734. Missing or empty |title= (help)
  8. Smith N, Lopez RA, Silberman M. PMID 29261964. Missing or empty |title= (help)
  9. Alyeşil C, Doğan NÖ, Özturan İU, Güney S (June 2017). "Distributive Shock in the Emergency Department: Sepsis, Anaphylaxis, or Capillary Leak Syndrome?". J Emerg Med. 52 (6): e229–e231. doi:10.1016/j.jemermed.2017.01.012. PMID 28238385.
  10. Parrillo, Joseph E.; Ayres, Stephen M. (1984). Major issues in critical care medicine. Baltimore: William Wilkins. ISBN 0-683-06754-0.
  11. Judith S. Hochman, E. Magnus Ohman (2009). Cardiogenic Shock. Wiley-Blackwell. ISBN 9781405179263.



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