Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Inadequate tissue perfusion due to heart pump failure +++ Epidemiology + • 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 +++ References ++Eastridge BJ et al: Hypotension begins at 110 mm Hg: redefining âhypotensionâ 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] Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth