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Flashcards in Cardiogenic shock Deck (10):

What is cardiogenic shock?

A state of inadequate tissue perfusion primarily due to cardiac dysfunction. May occur suddenly or after progressively worsening heart failure


What are the causes of cardiogenic shock?

Pulmonary embolism
Tension pneumothorax
Cardiac tamponade
Myocardial depression- drugs, hypoxia, acidosis, sepsis
Valve destruction (endocarditis)
Aortic dissection


How is cardiogenic shock managed?

1. Oxygen
2. Diamorphine
3. Investigations and close monitoring
4. Correct arrhythmias; U&E abnormalities or acid-base disturbance
5. Optimize filling pressure with clinical assessment of pulse, BP, JVP/CVP. If in ICU consider using PICCO or LIDCO
6a) If underfilled give a plasma expander- 100ml every 15minutes IV aiming for MAP 70mmHg and CVP 8-10mmHg
6b) If well/over filled, ionotropic support e.g. dobutamine aiming for MAP 70mmHg
7. Look for and treat any reversible cause MI or PE. Consider thrombolysis or surgery for acute VSD; mitral or aortic incompetence


What are PICCO and LIDCO?

PICCO= pulse contour cardiac output and LIDCO= lithium dilution cardiac output. Both use injection (PICCO= cold water; LIDCO= lithium) to estimate filling pressure, extravascular fluid i.e. pulmonary oedema and cardiac output.


What is cardiac tamponade?

An acute type of pericardial effusion in which fluid, pus, blood, clots, or gas accumulates in the pericardium resulting in slow or rapid compression of the heart. In essence: pericarial fluid collects, intra-pericardial pressure rises, heart cannot fill?, pumping stops


What are the causes of cardiac tamponade?

Lung/breast cancer
Myocardial infarct
Bacteria e.g. TB


What are the three main signs of cardiac tamponade? What are these known as?

Falling BP
Rising JVP
Muffled heart sounds

Beck's triad


What is Kussmaul's sign?

Raised JVP on inspiration


What is pulsus paradoxus?

Pulse fades on inspiration


How should cardiac tamponade be treated?

Prompt pericardiocentesis brings swift relief. While awaiting this giev oxygen, monitor ECG and set up IVI