Skip to Main Content


  • • Inadequate tissue perfusion due to heart pump failure




  • • Arrhythmia

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

    • Ischemia-induced myocardial failure

    • Valvular or septal defects

    • Systemic or pulmonary hypertension

    • Myocarditis

    • Myocardiopathies


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

    • Decreased cardiac output

    • Peripheral hypoperfusion

    • Peripheral edema/pulmonary edema


  • • Intrinsic cardiac dysfunction

    • Myocardial ischemia

    • Arrhythmia


  • • Physical exam

    • ECG

    • Echocardiogram


  • • 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



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]

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.