298 Cardio Shock

Question 1

Most common joint etiology of Cardiogenic shock and pulmonary edema

Answer 1

Severe LV dysfunction from myocardial infarction

Question 2

Clinical features of peripheral hypoperfusion in cardiogenic shock

Answer 2

Elevated arterial lactate of more than 2 mmol/L

Question 3

Uncommon cause of transient Cardiogenic shock

Answer 3

Takotsubo syndrome

Question 4

Type of Myocardial infarct associated with cardiogenic shock

Answer 4

Anterior wall myocardial infarction

Question 5

Associated with increased risk for cardiogenic shock

Answer 5

Patients with MI
Patient with prior MI
Older age
Diabetes Mellitus
Anterior MI location
Multivessel CAD with extensive coronary artery stenoses

MADAM PO

Question 6

Target BP or MAP in patients with cardiogenic shock

Answer 6

MAP of 60-65 mmHg

Systolic BP of 90 mmHg

Question 7

Target blood glucose level in acute myocardial infarction

Answer 7

CBG less than 180 mg/dL

Question 8

Only evidence based treatment strategy for mortality reduction in cardiogenic shock

Answer 8

Rapid revascularization of infarct related artery

Question 9

Preferred reperfusion strategy

Answer 9

PCI with drug-eluting stent of the infarct related artery

Question 10

Reasonable first line vasopressor. Started at what dose

Answer 10

Norepinephrine 2 to 4 mcg/min titrated upward based on blood pressure

Question 11

Why is Dopamine avoid as first line therapy for MI with cardiogenic shock

Answer 11

Dopamine has proarhythmogenic effect

Question 12

Synthetic sympathomimetic amine with positive inotropic action and minimal positive chronotropic activity. Preferred dose and why?

Answer 12

Dobutamine at 2.5 mkm. Higher doses have moderate chronotropic activity

Question 13

Most commonly used mechanical circulatory support device. When is it contraindicated?

Answer 13

Intra aortic balloon pump (IABP)

No longer recommended for CS with LV failure

Question 14

Six variables in the IABP Shock II score

Answer 14

Age more than 75
Prior stroke
Glucoze more than 191 mg/dl or 10.6 mmol on admission
Creatinine of more than 132.6 mmol/L
TIMI score after PCI less than 3
Arterial blood lactate more than 5 mmol/L

GAP CAT

Question 15

Predominant RV failure accounts for how many percent of cardiogenic shock

Answer 15

5%

Question 16

Most common cause of RV failure

Answer 16

Proximal RCA occlusion

Question 17

What is the target in fluid resuscitation in RV CS?

Answer 17

Fluid administration to optimize right atrial pressure 10-15 mmHg

Question 18

Complication of Acute MI that often occurs on the first day with a second peak several days later

Answer 18

Acute severe MR due to papillary muscle dysfunction

Question 19

Rare complication of Acute myocardial infarction that occurs 24H after but may occur up to 2 weeks later

Answer 19

Ventricular septal rupture occurs 1-2% in patient with cardiogenic shock withOUT reperfusion and reduced to 0.2% in era of reperfusion

Question 20

Definitive treatment of Acute severe mitral regurgitation resulting from acute myocardial infarction

Answer 20

Mitral valve repair or reconstruction

Question 21

Dramatic complication of Acute myocardial infarction occurring during first week. Presents with sudden loss of pulse, BP and consciousness but sinus rhythm on ECG (Pulseless electrical activity) due to cardiac tamponade

Answer 21

Myocardial free wall rupture

Question 22

Target oxygenation saturation in pulmonary edema

Answer 22

O2 sat of 92%

Question 23

Venodilatoe that rapidly reduced preload before any diuresis occurs. Diuretic of choice. What’s the initial dose and higher dose?

Answer 23

Furosemide. Initial dose of 0.5 mg/kg. Higher dose of 1 mg/kg

Question 24

First line therapy for acute cardiogenic pulmonary edema

Answer 24

Sublingual nitroglycerin 0.4 mg x 3 every 5 mins

If still persists, IV nitroglycerin 5 - 10 mcg/min

Question 25

Potent venous and arterial vasodilator but not recommended in states of reduced coronary artery perfusion

Answer 25

Nitroprusside 0.1-5 mcg/kg/min

Question 26

Transient venodilator that reduced preload while relieving dyspnea and anxiety

Answer 26

Morphine

Question 27

Reduces both preload and afterload with known mortality benefit

Answer 27

ACE inhibitors

Question 28

IV recombinant brain natriuretic peptide reserved for refractory pulmonary edema not due to myocardial ischemia

Answer 28

Nesiritide

Question 29

Bipyridine phosphodiesterase-3 inhibitors (inodilators) which stimulate myocardial contractility while promoting peripheral and pulmonary vasodilation

Answer 29

Milrinone 50 mcg/kg followed by 0.25- 0.75 mcg/kg/min

Question 30

How to prevent high altitude pulmonary edema

Answer 30

Dexamethasone
CCB
LABA