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CVICU Pathophysiology Packet > Cardiogenic Shock > Flashcards

Cardiogenic Shock Flashcards

1
Q

What is cardiogenic shock?

A

a condition where your heart can’t pump enough blood to meet your body’s needs

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2
Q

What is the most likely cause of cardiogenic shock?

A

It is most often caused by a severe heart attack

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3
Q

What are the first three things that happen during the cardiogenic shock cycle?

A

*Cardiac output decreases.
*Hypotension ensues.
*Heart rate increases to compensate for hypotension.

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4
Q

Once the heart rate increases to compensate for hypotension, what happens next during cardiogenic shock?

A

*Peripheral vasoconstriction occurs.
*Blood is redirected away from the gut.

Chemicals released by dying cells cause further suppression of myocardial function and increase vasoconstriction centrally

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5
Q

When the heart must work harder, what is increased?

A

oxygen demand

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6
Q

How does cardiogenic shock end a person’s life?

A

Vital organs such as the brain, kidneys, and lungs are hypoperfused causing permanent damage

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7
Q

Hypoperfusion to the heart and lungs can cause what symptoms?

A

· Rapid breathing
· Severe shortness of breath
· Sudden, rapid heartbeat (tachycardia)

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8
Q

what neurological symptoms might be seen? Why?

A

· Confusion
· Loss of consciousness or fainting

Hypoperfusion to the brain

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9
Q

What symptoms may indicate poor perfusion in cardiogenic shock?

A

· Weak pulse
· Sweating
· Pale skin
· Cold hands or feet

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10
Q

What might the patient tell you they are feeling?

A

· Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
· Pain extending beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
· Increasing episodes of chest pain
· Prolonged pain in the upper abdomen
· Impending sense of doom
· Fainting
· Nausea and vomiting

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11
Q

Other than an MI, what are other causes of cardiogenic shock?

A

Myocarditis
Endocarditis
Drug abuse
Poisoning

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12
Q

What are the most severe outcomes of cardiogenic shock?

A

A large section of heart muscle that no longer moves well or does not move at all ·Breaking open (rupture) of the heart muscle due to damage from the heart attack · Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia

· Pressure on the heart due to a build up of fluid around it (pericardial tamponade)

· Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve

· Tear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers)

· Very slow heart rhythm (bradycardia) or problem with the electrical system of the heart (heart block)

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13
Q

This is a buildup of fluid around the heart

A

pericardial tamponade

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14
Q

What is myocarditis?

A

Inflammation of the heart muscle

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15
Q

What are 3 risk factors of cardiogenic shock

A

previous MI
being 65 years or older
CAD

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16
Q

What is the initial mangement of cardiogenic shock?

A

Initial management includes fluid resuscitation to correct hypovolemia and hypotension

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17
Q

What is the exception to the initial management of cardiogenic shock?

A

If pulmonary edema is present

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18
Q

What is required to know if your patient has pulmonary edema?

A

swan ganz

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19
Q

What is routine in a patient who is admited for cardiogenic shock?

A

Central venous and arterial lines are often required. Swan-Ganz catheterization and continuous percutaneous oximetry are routine

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20
Q

Because oxygenation and airway protection are critical, what may be required?

A

Intubation and mechanical ventilation

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21
Q

How can intubation cause harm to a patient in cardiogenic shock?

A

positive pressure ventilation may improve oxygenation, it may also compromise venous return, preload, to the heart

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22
Q

What are 3 drips used to combat hypotension during cardiogenic shock?

A

Dopamine, norepinephrine, and epinephrine

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23
Q

What is the mean blood pressure required for adequate splanchnic and renal perfusion?

A

MAP of 65

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24
Q

What type of catheter may be helpful in guiding fluid resuscitation in situations in which LV preload is difficult to determin

A

pulmonary artery catheter (swan ganz)

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25
Q

Cardiogenic shock may be indicated by a cardiac index of less than…

A

1.8-2.2 L/min/m2

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26
Q

What is a normal cardiac index?

A

2.5-4

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27
Q

What is a cardiac index?

A

The cardiac index (CI) is an assessment of the cardiac output value based on the patient’s size

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28
Q

How is cardiac index calculated?

A

divide the cardiac output by the person’s body surface area (BSA)

29
Q

What monitoring system would show you your patient’s CI (cardiac index)?

A

Swan Ganz

30
Q

Cardiogenic shock may be indicated by a pulmonary capillary wedge pressure greater than…

A

15-18 mm Hg

31
Q

What is a normal pulmonary capillary wedge pressure?

A

4-12 mm Hg

32
Q

What does an elevated pulomary capillary wedge pressure (PCWP) indicate?

A

severe left ventricular failure or severe mitral stenosis

33
Q

What is stroke volume index?

A

Stroke volume index is the volume of blood pumped by the heart with each beat (in milliliters) divided by the body surface area (square meters)

34
Q

What is a normal SVI?

A

35-65mL/m2.

35
Q

What is Left ventricular stroke work index?

A

a beat-by-beat assessment of myocardial systolic and diastolic function that integrates systemic hemodynamics to produce a comprehensive measure of cardiac performance

36
Q

Why would a cardiogenic shock patient require strict I&Os?

A

To measure kidney function

37
Q

What labs might be ordered?

A

BMP, RFP, CBC, cardiac enzymes, abg, lactate, bnp

38
Q

List 3 reasons why a CBC would be helpful in a patient experiencing cardiogenic shock.

A

A complete blood count (CBC) is generally helpful to exclude anemia.
A high white blood cell (WBC) count may indicate an underlying infection
platelet count may be low because of coagulopathy related to sepsis

39
Q

The diagnosis of acute myocardial infarction (MI) is aided by a variety of serum markers, which include creatine kinase and its subclasses…

A

troponin, myoglobin, and LDH.

40
Q

Which cardiac enzyme is the most specific to MI?

A

The value for the isoenzyme of creatine kinase with muscle and blood subunits is most specific

41
Q

Creatine kinase may be falsely elevated in people with what conditions?

A

myopathy, hypothyroidism, renal failure, or skeletal muscle injury.

42
Q

The rapid release and metabolism of ____ occurs in persons with MI

A

myoglobin

43
Q

A ____ rise of myoglobin over 2 hours appears to be a test result that is sensitive for MI.

A

4x

44
Q

The serum LDH value increases approximately ___s after the onset of MI,

A

10 hours

45
Q

The serum LDH value peaks at ___ after the onset of an MI

A

peaks at 24-48 hour

46
Q

The serum LDH value gradually returns to normal in ___ after onset of MI

A

6-8 days

47
Q

Which 2 cardiac troponins are commonly used for the diagnosis of myocardial injury?

A

T and I

48
Q

Troponin elevation in the absence of clinical evidence of ischemia should prompt…

A

a search for other causes of cardiac damage, such as myocarditis

49
Q

Troponin I and T can be detected in serum within ___ after onset of acute MI

A

a few hours

50
Q

When do troponin levels peak?

A

14 hours after MI AND several days later

51
Q

What is the second troponin peak called?

A

biphasic peak

52
Q

How long do troponins remain abnormal?

A

up to 10 days

53
Q

Troponin T can be used as a patient risk-stratifying tool in patients with

A

unstable angina or non–Q-wave MI

54
Q

ABG:
A base deficit elevation (reference range is ___) correlates with the occurrence and severity of shock.

A

+3 to -3 mmol/L

55
Q

ABG:
A base deficit is also an important marker to follow during

A

resuscitation of a patient from shock.

56
Q

Elevated lactate values in a patient with signs of hypoperfusion indicate a poor prognosis; rising lactate values during resuscitation portend a …

A

very high mortality rate.

57
Q

Brain natriuretic peptide (BNP) may be useful as an indicator of …

A

congestive heart failure and as an independent prognostic indicator of survival

58
Q

A low BNP level may effectively ___ cardiogenic shock in the setting of hypotension

A

rule out

59
Q

an elevated BNP level does not __ cardiogenic shock

A

rule in

60
Q

An echocardiogram can help identify

A

whether an area of your heart has been damaged by a heart attack and isn’t pumping normally.

61
Q

Coronary catheterization (angiogram). This test can show

A

if your coronary arteries are narrowed or blocked

62
Q

What happens during an angiogram (aka heart cath)

A

A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that’s pushed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage

63
Q

During a cardiac cath, what procedure can also be done?

A

Angioplasty

64
Q

Angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to…

A

widen the blocked area. In most cases, a mesh tube (stent) is also placed inside the artery to hold it open more widely and prevent re-narrowing in the future.

65
Q

What 2 medical PROCEDURES may occur in a patient with cardiogenic shock?

A

angioplasty or balloon pump

66
Q

What does a balloon pump do?

A

The balloon pump inflates and deflates to mimic the pumping action of the heart, helping blood flow through

67
Q

What are surgeries that can help fix cardiogenic shock?

A

CABG, surgical repair of tear or valve, LVAD, or heart transplant

68
Q
A

CVICU Pathophysiology Packet (2 decks)

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