Cardiogenic shock resident survival guide

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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:

• 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

Common Causes

• Cardiogenic shock

• Pump problems MI with LV failure (the most common cause), cardiomyopathy post-MI, ventricular septal rupture, contained free wall rupture, and papillary muscle rupture.
• Mechanical (e.g. cardiac tamponade, tension pneumothorax), aortic stenosis, which is considered as obstructive shock too.
• Electrical eg VT or AF or most fundamentally VF

Management

Shock

ABCD Airway / O2 / 2 wide bore IV access / 12-lead ECG / focused H&P / CXR

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