CARDIOGENIC SHOCK

-RAKSHA YADAVB.Sc Nursing 2nd Year

AIIMS, JODHPUR

Cardiogenic shock Definition Predisposing/Risk factors Etiological factors Pathophysiology Clinical Manifestations Complications Diagnostic tests Medical Management

-Pharmacological Management

-Surgical Management Nursing Management Prevention of cardiogenic shock

Definition

What is Cardiogenic shock?

Cardiogenic shock is defined as heart’s inability to contract and pump blood efficiently due to inadequate supply of O2 & nutrients to the heart.

Most often caused by severe heart attack. Mortality rate is very high (50-75%), if not

treated immediately

Predisposing/Risk Factors

Older age A history of heart attacks or heart failure Coronary heart disease (CHD)- Affects all the

major blood vessels of heart Hypertension Diabetes Obesity Atherosclerosis

Etiological Factors• Acute MI• Severe hypoxemia• Cardiomyopathy• Pericardial tamponade

• Acidosis• Dysrhythmias• Trauma

• Structural abnormalities • Valvular abnormality• Ventricular septal rupture• Tension pneumothorax

Pathophysiology

↓ Cardiac Contractibility

↓ Stroke Volume & C.O

Pulmonary

Congestion

↓Systemic Tissue

Perfusion

↓ Coronary

Artery Perfusion

Clinical Manifestations Angina Pectoris, squeezing pain in center of chest. Dysrhythmias Diminished heart sounds Acute drop in blood pressure > 30 mm Hg Decreased cardiac output Tachypneas, shortness of breath Weak, thready pulse Sweating, cold hand & feet Urine output < 30 mL/hr Cool, pale, moist skin

Complications

Brain damage Kidney damage Liver damage Multiple organ failure Coma Death

How is Cardiogenic shock diagnosed?

Blood pressure test Electrocardiogram Echocardiography Chest X-ray Cardiac enzyme test Coronary angiography Pulmonary artery catheterization Blood tests:

- ABG, LFT, RFT

Medical Management

Correction of underlying cause: → Correction of the underlying cause is very important as it may lead to:- Fail of the compensatory mechanisms- It can reduce the effectiveness of the

interventions

→ Correction of:- Dysrhythmia- Acidosis & electrolyte disturbances

Initiation of first line treatment:

→ Oxygenation- Nasal cannula @ 2-6 lpm

→ Hemodynamic Monitoring- BP

→ Fluid Therapy- RL, NS, Dextran

→ Pain Control- Morphine

Pharmacological Management:

→ Dobutamine

→ Nitroglycerine (Vasodilator)

→ Dopamine

→ Vasoactive Medications

> Epinephrine

> Nor- Epinephrine

> Vasopressin (ADH)

Surgical Management:

→ CABG (Coronary artery bypass graft)

→ Replacement of Faulty Cardiac valve

Nursing Management : Our main Focus

Monitoring Hemodynamic Status: Assess vitals regularly. Maintain a patent arterial line, if any Assess functioning of ECG monitor &

readings

Administering medications & IV fluids: Monitor vitals before and after administering

medications & IV fluids. Administer prescribed medications & fluids

accurately (Follow10 Rights) Assess IV infusion site for bleeding or any

allergic response. Monitor:

- Urine Output

- BUN Indicators of renal function

- Serum Creatinine

Preventing Complications: Notify the physician promptly if:

- Hemodynamic, Cardiac or Pulmonary status changes.

- Decline in ABG or Pulse Oximeter values

- Adventitious breath sounds heard

- Changes in cardiac rhythm

Limit myocardial oxygen demand by: Administering analgesics, sedatives, and other agents

as prescribed. Positioning the patient for comfort. Limiting activities. Providing calm and quiet environment Offering support to reduce anxiety. Teaching the patient about his condition.

Enhancing myocardial oxygen supply by: Administering oxygen. Monitoring the patient’s respiratory status. Administering prescribed medications.

How can Cardiogenic shock be prevented?

Adopt ‘Heart healthy lifestyle’ Take healthy diet

- Low in sodium & fat Control hypertension and diabetes Reduce obesity- Be physically active Quit smoking If lifestyle changes are not enough, Take all of

your medicines as prescribed.