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  • • Inadequate tissue perfusion due to heart pump failure

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Epidemiology

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  • • Arrhythmia

    • Bradycardia (< 50 bpm) or tachycardia (> (230 - age)×0.8)

    • Ischemia-induced myocardial failure

    • Valvular or septal defects

    • Systemic or pulmonary hypertension

    • Myocarditis

    • Myocardiopathies

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  • • Elevated right heart/central venous and jugular venous pressure

    • Decreased cardiac output

    • Peripheral hypoperfusion

    • Peripheral edema/pulmonary edema

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  • • Intrinsic cardiac dysfunction

    • Myocardial ischemia

    • Arrhythmia

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  • • Physical exam

    • ECG

    • Echocardiogram

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  • • Aimed at underlying medical condition and optimizing cardiac output

    Opioids relieve pain, provide sedation, block adrenergic discharge, decrease right ventricular filling, and lessen stress on heart

    Diuretics decrease vascular volume, decrease right and left atrial pressures, and alleviate peripheral and pulmonary edema

    Chronotropes rarely indicated, should be used to raise heart rate only to tolerable levels

    Inotropes increase blood flow in the cardiovascular system

    Vasodilators in patients with elevated systemic vascular resistance

    • β-Blockers in those with ischemia and a rapid heart rate

    Vasoconstrictors are occasionally useful to increase coronary perfusion pressure

    • Transaortic balloon pump is effective in resuscitating selected patients with severe reversible LV dysfunction

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References

Eastridge BJ et al: Hypotension begins at 110 mm Hg: redefining “hypotension” with data. J Trauma 2007;63:291.  [PubMed: 17693826]
Finfer S et al: A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247.  [PubMed: 15163774]
Fleisher LA, Eagle KA: Clinical practice. Lowering cardiac risk in noncardiac surgery. N Engl J Med 2001;345:1677.  [PubMed: 11759647]

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