cardiogenic shock

SOEPEL: 1

Presented by: Abdul Waris Khan

Rotation: Internal medicine

Cardiogenic shock

SOEPEL

• Subjective:

• Chief complaint: 38-year-old female presented to ER with Severe

headache, SOB, dizziness, confusion, nausea, and palpitations.

• H/O presenting illness: The symptoms started 2 hours prior to the

admission to ER. She is a known case of HTN and a week ago was

diagnosed with MI.

No significant past medical or family history.

• Objective:

• She was afebrile

• GCS of 12/15

• HR:100 beats/min (bpm)

• BP 176/117 mm Hg

• RR: 24

• Evaluation:

• coronary artery disease (CAD),

• pulmonary embolism (PE),

• subarachnoid hemorrhage,

• Takotsubo cardiomyopathy,

• Plan

• ECG, CT, Echo, Cardiac enzymes, ABGs, V/Q scan

• Elaboration

• Resuscitate

• Oxygen

• Diamorphine

• Thrombolysis if MI

• Learning goals:

Cardiogenic shock

What is shock !!!!?

• Shock is the term used to describe acute circulatory

failure with inadequate or inappropriately distributed

tissue perfusion resulting in generalized cellular hypoxia

and/or an in ability of the cells to utilize oxygen.

Definition

Cardiogenic shock (CS) is characterized by systemic hypoperfusion due to

severe depression of the cardiac index [<2.2 (L/min)/m2] and sustained

systolic arterial hypotension (<90 mmHg).

Statistics

• CS is the leading cause of death of patients hospitalized with MI. Early reperfusion therapy

for acute MI decreases the incidence of CS.

• LV failure accounts for ~80% of the cases of CS complicating acute MI. Acute severe mitral

regurgitation (MR), ventricular septal rupture (VSR), predominant right ventricular (RV)

failure, and tamponade account for the remainder

Causes

Clinical presentation

Cardiogenic shock • Signs of myocardial failure, e.g.

• Raised jugular venous pressure (JVP)

• Pulsus alternans/paradoxus

• ‘Gallop’ rhythm,

• Basal crackles,

• Pulmonary oedema.

• Tachypnoea

• Tachycardia

• Cold/clammy extremities

• Drowsiness

• Confusion

• Oliguria

Patient Profile

• In patients with acute MI, older age, female sex, prior MI, diabetes, and anterior MI location

are all associated with increased risk of CS.

• Reinfarction soon after MI increases the risk of CS.

• Two-thirds of patients with CS have flow-limiting stenoses in all three major coronary

arteries, and 20% have left main coronary artery stenosis.

• CS may rarely occur in the absence of significant stenosis, as seen in Takotsubo

cardiomyopathy, often in response to sudden severe emotional stress.

Diagnosis

• If MI suspected:

• Echocardiography

• ECG

• Cardiac enzymes

References

• Kumar and Clark clinical medicine 7th edition

• Davidson principals and practice of medicine 21st edition

• Harrison internal medicine 17th edition

THANK YOU