Cardiogenic Shock
·
Blood
flow decreased due to an intrinsic defect in cardiac function -either the heart
muscle, or the valves are dysfunctional.
·
Heart
is unable to pump the blood to body.
·
In
myocardial infarction, when the amount of damaged ischemic muscle may be so
great that the heart cannot pump anymore. The decreased contractility causes a
decrease in stroke volume.
Risk Factors for
Cardiogenic Shock
Coronary
Factors
·
Myocardial
infarction
Non-coronary
Factors
·
Cardiomyopathies
·
Valvular
damage
·
Cardiac
tamponade
·
Dysrhythmias
·
Hypovolemia
·
Pulmonary
edema (non cardiogenic)
Pathophysiology:
↓cardiac
contractibility → ↓ in stroke volume
and C.O. → pulmonary congestion, ↓ed systemic perfusion , ↓coronary artery
perfusion
Clinical Features:
Angina
pectoris,
Dysrhythmias,
Dimionished
heart souds
Acute
↓ in BP ( > 30mmHg)
↓Cardiac
output
Tachypnoea,
shallow breath
Perfused
sweating, cold and clammy extremities
Weak
, thready pulse
Management
Primary
goal is to improve myocardial muscle function
Inotropes:
Dobutamine increases myocardial contractility in the presence of normal or
slightly decreased blood pressure
Intra-aortic
balloon pump: reduces the workload of the heart and improves perfusion of
the coronary artery.
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