Cardiogenic Shock

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Cardiogenic Shock

• Left Ventricular Failure vs. Right Ventricular
  Failure

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Topics

• Definition
• Causes
• Coronary Artery Circulation
• Left Ventricular Failure
• Right Ventricular Failure

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Cardiogenic Shock

• Definition

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Causes of Cardiogenic Shock

• Failure to overcome afterload
• Hypertension
• LVI
• Inadequate preload
• Rate or fluid problem
• RVI

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Coronary Artery Circulation

• Right Coronary Artery
• Left Anterior Descending
• Left Circumflex

• Right Ventricular Wall
• Inferior surface of LV
• Posterior surface of LV
• SA AV nodes
• LV septum
• Anterior surface of LV
• Lateral surface of LV

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Left Ventricular Failure

• Congestive Heart Failure
• Pathophysiology
• CO doesnt exceed afterload
• Blood backs up into pulmonary circulation
• Pulmonary edema
• Hypertension or Hypotension?

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LVF Causes

• Chronic Hypertension
• Acute MI w/ occlusion of LAD or LCx
• Anterior, Septal and Lateral infarct

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LVF Assessment

• Presence of Cardiogenic Shock?
• Halmark
• Pulmonary Edema
• Rales, Rhonchi
• Wheezes (Cardiac Asthma)
• May have concomitant signs of RVF

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LVF Management

• Aimed at ? CO or ? afterload
• IV, O2, Monitor (12 lead)
• BVM w/ PEEP/CPAP if appropriate
• Normo-/Hypertensive
• NTG, ASA, MS, Lasix
• Hypotensive
• Inotropes
• Limit fluids

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RVF Pathophysiology

• Decreased contractility of RV
• Decreased preload to LV
• Blood backs up into venous system

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Causes of RVF

• Concomitant LVF
• Occlusion of RCA
• Right Ventricular Infarct

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Assessment of RVF

• Classic Triad!
• JVD, Hypotension, Clear Lungs
• If hypotensive w/ wet lungs LVF!

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Management of RVF

• Aimed at increasing preload to LV
• IV, O2, Monitor (12 lead is diagnostic)
• BVM assist if appropriate
• Fluid challenge to ? preload
• Very cautious with NTG, Lasix or MS
• Inotropes if fluid doesnt work or lungs become
  wet