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Cardiogenic
Shok
Some Notes
Develops in 10% to 20% of patients
hospitalized AMI
Mortality of such patients
approximately 80% or higher
Very few patients develop shock
immediately after AMI
About half of the patients develop
shock within 24h
Pathology
Clinical signs
ECG shows the pattern of AMI or acute
coronary insufficiency
The SBP < 80 mm Hg *
Pulse rate is 100 per min or faster**
The urinary output is low, 30 ml or less
per hour
There are clinical signs of peripheral
circulatory collapse
Differential diagnosis
Massive pulmonary embolism
Acute dissecting aneurism of the aorta
Acute cardiac tamponade
Acute hemorrhage
Cerebrovascular thrombosis
Diabetic acidosis
Acute pancreatitis
Acute adrenal insufficiency
Starlings law of the heart
The ability of the heart to
increase its output in response
to an increase in venouse return
represents a positive feedback in
which altered blood flow to the
heart leads to a corresponding
change in blood flow leaving the
heart.
Emergency treatment
The first priority in treating
cardiogenic shock is to expand
the circulating blood volume
with IV fluids , using the PWP or
CVP as a basic guide
Initial treatment
1. Position the patient*
2. Make certain that there is an adequate
airway**
3. Maintain adequate oxygenation***
4. Start an IV infusion of D5W,using a
regular drip bulb at a minimal flow rate
5. Insert a Swan – Ganz catheter into the PA
6. Draw blood for the tests
Initial treatment
1. Insert a Foley catheter into the
urinary bladder to obtain accurate
measurements of urinary output*
2. Monitor the patient continuously**
3. Relieve pain***
4. Relieve agitation****
5. Take portable X – ray films of the
chest
Definitive treatment
Correction of hypovolemia
Treatment of arrhythmias
Treatment of hypotension
Treatment of metabolic acidosis
Treatment of electrolyte disturbances
Mechanical circulatory assist
Correction of hypovolemia
PWP less than 15 mm Hg
PWP remain stable .16 mm Hg
Initial PWP is between 15 – 18 mm Hg
PWP is 20 mmHg or higher*
Rise in PWP to 16 mm Hg or higher
PWP is low approximately 5 mm Hg
Pulmonary edema**
Schematic guide
Group 1 Low PWP
without PE - IV fluids
indicated
Group 2 Low PWP with
PE - IV fluids indicated
Grout 3 High PWP
without PE Vasodilatators, MCD
Group 4 High PWP with
PE - Treatment as G3
Eugene Yevstratov MD
Phone: 0054111540682712 (ARG)
Private: 0030372236344 /
0030372231698(UKr)
Fax: 001 775 796 2780 (USA)
Email: ostlandfox@yahoo.de /
ostlandfox@medscape.com
Link: http://myprofile.cos.com/eugenefox
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