Cardiogenic shock

Cardiogenic shock
Updated: 06/23/2022
© Jun Wang, MD, PhD

General features
  • Reduced cardiac output due to severe ventricular dysfunction
  • Adequate circulating volume
  • Tissue hypoxia due to hypoperfusion
Etiology
  • Acute myocardial infarction: most common cause
  • Multivessel coronary artery disease
  • Arrhythmia
  • Mechanic defects: septal defect, papillary muscle rupture, etc
Key risk factors
  • Older age
  • Anterior myocardial infarction
  • History of hypertension, diabetes mellitus, multivessel coronary artery disease, myocardial infarction
  • Systolic BP< 120 mmHg
  • Heart rate > 90 beats per minute
  • Heart failure at admission
  • EKG findings of ST-elevation and left bundle branch block
Clinical presentations
  • Presentation associated with underlying cause: acute myocardial infarction, etc
Chest pain
Difficulty in breathing
Tachycardia
Hypotension
Tachypnea
  • Physical examination findings
Distended jugular vain
Coolness of skin
Gallop rhythm
Distant heart sounds, new murmurs
Pulmonary rales
Rapid and faint pulse 
Reduced urine output
Altered mental status
Key Laboratory findings
  • Myocardial ischemia: Cardiac enzymes (CK, CK-MB, troponins, myoglobin, etc)
  • Metabolic acidosis: elevated lactate, reduce bicarbonate
  • Renal hypoperfusion: elevated BUN, creatinine
Diagnosis
  • Rapid diagnosis key for successful management
  • History of chest pain or difficulty breathing (acute myocardial infarction)
  • PE findings of hypotension, hypoperfusion and pulmonary congestion
  • EKG findings, laboratory findings, etc
Management
  • Ventilatory support
  • Hemodynamic support
  • Treat underlying cause: restoration of coronary blood flow, etc
  • Correction of electrolyte and acid-base imbalance


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