Cardiogenic Shock

Cardiogenic Shock

• Caused whenever the heart’s pumping ability becomes impaired resulting in a decrease cardiac output

Causes of Cardiogenic Shock

• Any condition that causes dysfunction of the left ventricle, the right ventricle, or both

  • Due to ischemia

  • Structural problems

  • Dysrhythmias

Cardiogenic Shock (How it Compares to HF)

• How is it different from HF?

  • NOT oxygenating & NOT perfusing to the rest of the body

• How is it the same to HF?

  • Heart is NOT pumping effectively

  • Same Sx

Cardiogenic Shock (Patho.)

• Decreased cardiac contractility → Decreased stroke volume & CO

• Leads to:

  • Pulmonary congestion

  • Decreased systemic tissue perfusion

  • Decreased coronary artery perfusion (Leads to decreased cardiac contractility again)

Cardiogenic Shock (S/S)

• CO/ CI:

  • Low cardiac output

• B/P:

  • Low

• Peripheral pulses:

  • Weak

  • Decreased

• Skin

  • Cool & clammy

• Urine output

  • Decreased

• LOC:

  • Decreases as it progresses

• Heart failure S/S:

  • Pulmonary congestion

  • Restlessness

  • Confusion

  • Tachycardia

  • Exertional dyspnea

  • Fatigue

  • Cyanosis

Compare & Contrast w/ Hypovolemic Shock

• Initial cause:

  • Hypovolemic: Volume issue

  • Pumping issue: Cardiogenic

• S/S

  • Cardiogenic shock has HF S/S

• Collaborative Interventions

  • Hypovolemic: Fluids

  • Cardiogenic: Diuretics & Inotropes

• Expected Outcome

  • Hypovolemic: Has a better outcome

  • Cardiogenic: Worst outcome (Pump issue)(Heart transplant)

• How to differentiate?

  • Listen to the lungs (Crackles)

  • Fluid overload = Cardiogenic

Interventions For Cardiogenic Shock

• Oxygenation

• Increased CO

• Decrease Left ventricular workload

• Intra-aortic balloon pump

• Impella

• Ventricular Assist Device (VAD)

• ECMO

Interventions For Cardiogenic Shock (Increased CO)

• Correct any dysrhythmias

• Correct any hypovolemia (Or hypervolemia)

• Medication

  • Inotrope (Increases contractility)

  • Vasopressor

  • Vasodilator (Nitroglycerin)

Interventions For Cardiogenic Shock (Decrease L Ventricular Workload)

• Vasodilators to decrease afterload

  • Nitroglycerin

  • Nitroprusside

  • If SBP > 110 = Start vasodilator

  • Give w/ an inotrope

• Correct fluid balance

  • Hypovolemia or Hypervolemia

• Decrease the workload of the heart