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Cardiogenic Shock: Clinical Manifestations, Pathophysiology and Management


Definition of Cardiogenic Shock

Cardiogenic shock is defined as any signs of tissue hypoperfusion, heart failure caused by low preload corrected. There is no clear definition of hemodynamic parameters, but cardiogenic shock is usually characterized by decreased blood pressure (systolic less than 90 mmHg, or reduction in mean arterial pressure over 30 mmHg) and or a decrease in urine output (less than 0.5 ml / kg / hour) with a pulse rate of more than 60 times per minute with or without the presence of organ congestion. There are no clear boundaries, between low cardiac output syndrome with cardiogenic shock. (Www.fkuii.org)

Cardiogenic shock is the end stage left ventricular dysfunction or congestive heart failure, occurs when the left ventricle had extensive damage. Contractility of heart muscle loses strength, causing a decrease in cardiac output with inadequate tissue perfusion to vital organs (heart, brain, kidneys). The degree of shock is comparable with left ventricular dysfunction. Although cardiogenic shock is usually often occur as a complication of MI, but can also terajdi in cardiac tamponade, pulmonary embolism, cardiomyopathy, and dysrhythmias. (Brunner & Suddarth, 2001)

Cardiogenic shock is the shock caused by inadequate cardiac function, as in myocardial infarction or mechanical obstruction of the heart; manifestations include hypovolemia, hypotension, cold skin, weak pulse, mental confusion, and anxiety. (Dorland Medical Dictionary, 1998)


Clinical Manifestations

Cardiogenic shock is characterized by impaired left ventricular function, resulting in impaired left ventricular function which resulted in severe disruption on tissue perfusion and oxygen delivery to tissues typical of cardiogenic shock caused by acute myocardial infarction is 40% or more loss of muscle tissue in the left ventricle and necrosis vocals throughout the ventricles due to an imbalance between myocardial oxygen demand and supply.

Clinical Manifestation left heart failure:
  • Shortness of breath dyspnea on effert, paroxymal nocturnal dyspnea
  • Cheyne stokes breathing
  • Coughing
  • Cyanosis
  • Hoarseness
  • Ronchi wet, soft not loud in the basal pulmonary hydrothorax
  • Cardiac abnormalities such as enlargement of the heart, the rhythm gallops, tachycardia
  • Abnormalities in X-rays

Pathophysiology of Cardiogenic Shock

Signs and symptoms of cardiogenic shock reflects the nature of the circulation of the pathophysiology of heart failure. Heart damage resulting in decreased cardiac output, which in turn lowers blood pressure artery to the vital organs. Blood flow to the coronary arteries is reduced, so that the intake of oxygen to the heart decreases, which in turn increases ischemia and further decreased the heart's ability to pump, eventually there was a vicious circle.

Classic sign of cardiogenic shock is low blood pressure, pulse rapid and weak, hypoxic brain that manifest in the presence of confusion and agitation, decreased urine output, and the skin cool and moist.

Dysrhythmias often occur due to decreased oxygen to the heart, such as in heart failure, the use of pulmonary artery catheter to measure left ventricular pressure and cardiac output is essential to assess the severity of the problem and evaluate the management that has been done. Increased left ventricular end-diastolic pressure of sustainable (LVEDP = Left ventricle End Diastolic Pressure) indicates that the heart fails to function as an effective pump.


Medical Management of Cardiogenic Shock

1. Make sure the airway is adequate, if not conscious, intubation should be performed.

2. Give oxygen 8-15 liters / minute by using a mask to maintain pO 2 70-120 mm Hg

3. Pain due to acute infarction, which can increase the shock that there must be overcome by administering morphine.

4. Correction of hypoxia, electrolyte disturbances and acid-base balance that occur.

5. If possible pairs of CVP.

6. Swans Ganz catheterization for hemodynamic research.


Reference

Alexander R H, H J. Proctor Shock. In the book: Advanced Trauma Life Support Course for Physicians. USA, 1993; 75-94
Atkinson R S, Hamblin J J, Wright J E C. Shock. In the book: Hand book of Intensive Care. London: Chapman and Hall, 1981; 18-29.
Bartholomeusz L, Shock, in the book: Safe Anaesthesia, 1996; 408-413
Franklin C M, Darovic G O, B and B. Monitoring the Patient in Shock. In the book: Darovic GO, ed, hemodynamic monitoring: Invasive and Noninvasive Clinical Application. USA: EB. Saunders Co.. 1995; 441-499.
Haupt M T, Carlson R W. Anaphylactic and anaphylactoid Reactions. In the book: Shoemaker WC, Ayres S, Grenvik A eds, Texbook of Critical Care. Philadelphia, 1989; 993-1002.
Leksana E. Fluid and Electrolyte Therapy. SMF / Division of Anesthesia and Intensive Therapy Faculty of Medicine, University of Diponegoro (FK UNDIP). Semarang. 2004:18.
Thijs L G. The Heart in Shock (With Emphasis on Septic Shock). In a collection of papers: Indonesian Symposium On Shock & Critical Care. Jakarta-Indonesia, August 30 - September 1, 1996; 1-4.
R M Wilson, ed. Shock. In the book: Critical Care Manual. 1981; c :1-42.
Zimmerman JL, Taylor RW, Dellinger RP, Farmer JC, Diagnosis and Management of Shock, in the book: Fundamental Critical Support. Society of Critical Care Medicine, 1997.

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1 comment:

  1. I am a medical resident on cardiology and I also wrote a few words about cardiogenic shock.

    ReplyDelete

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