Cardiogenic Shock

• • 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