Cardiogenic shock resident survival guide: Difference between revisions
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==Definition== | ==Definition== | ||
It is a state of end-organ hypoperfusion due cardiac failure leading to hemodynamic changes: | 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 | :*SBP < 80 mmHg or MAP < 30 mmHg than baseline | ||
:*Cardiac index ( '''CI''' ) < 1.8 L.Min<sup>-1</sup>·M<sup>-2</sup> without vasopressors support or '''CI''' 2.0 to 2.2 L.Min<sup>-1</sup>·M<sup>-2</sup> with vasopressors support. | :*Cardiac index ( '''CI''' ) < 1.8 L.Min<sup>-1</sup>·M<sup>-2</sup> without vasopressors support or '''CI''' 2.0 to 2.2 L.Min<sup>-1</sup>·M<sup>-2</sup> with vasopressors support. | ||
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===Prognosis=== | ===Prognosis=== | ||
Cardiogenic shock occurs in 8% of hospitalized STEMI patient with a mortality rate of 50-60% within 30 days. | |||
==Management== | ==Management== | ||
Revision as of 18:15, 4 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: MI (mainly in anterior wall) with LV failure (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.
Management
| Shock | |||||||||||||||||||||||||||||
| ABCD Airway / O2 / 2 wide bore IV access / 12-lead ECG / focused H&P / CXR | |||||||||||||||||||||||||||||
| {{{ C01 }}} | {{{ C02 }}} | {{{ C03 }}} | |||||||||||||||||||||||||||