PCM Cardiogenic shock Flashcards.txt

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PCM Cardiogenic shock Flashcards.txt
2011-11-14 18:33:24

Cardiogenic shock lecture
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  1. What are the 3 types of shock
    • Hypovolemic
    • Cardiogenic
    • Distributive
  2. Does preload increase or decrease in cardiogenic shock?
  3. Define Cardiogenic Shock
    decrease in CO with evidence of insufficient tissue perfusion in the presence of adequate intravascular volume
  4. What are the Hemodynamic criteria (Forrester class 4) for cardiogenic shock?
    • Sustained hypotension (SBP < 90 mmHg for >30min)
    • Increased LV filling (PCWP >15mmHg)
    • Reduced systolic cardiac function
  5. What are some MI causes of Cardiogenic shock
    • Severe LV dysfunction
    • Extensive RV infarction
    • Mechanical complications
    • acute mitral regurgitation
    • VSD
    • Free wall rupture
    • Conduction abnormalities
  6. What are some non MI causes of Cardiogenic shock?
    Myocarditis, end stage cardiomyopathy, myocardial contusion, LVOT obstruction, Obstructive tumor, septic shock with myocardial depression, pulmonary embolism, aortic dissection with acute AR or tamponade, stress cardiomyopathy (broken heart syndrome)
  7. What is the median time from MI to shock?
    7 hours
  8. What are the risk factors for development of CS?
    • Elderly age 70 and up
    • diabetes
    • anterior infarction
    • prior MI
    • 3 vessel left main disease
    • early use of beta blockers in large infarcts (can cause hypotension that may lead to shock)
  9. What are the potential therapies for Cardiogenic shock
    • Rx- pressors and inotropes
    • temporary pacing
    • Intra-aortic balloon pump (IABP)
    • Fibrinolytics
    • Revascularization: CABG/PCI
    • Ventricular assist devices (VADs)
    • Cardiac tranplantation
  10. Action of Norepinephrine
    vasoconstriction and inotropic stimulant
  11. Action of dopamine
    • at low doses � renal vascular dialation
    • at medium doses- chronotropic/inotropic (beta)
    • at high doses- vasoconstriction (alpha)
  12. Dobutamine action
    positive inotrope, vasodilates- decreases afterload so hard to give to a shock patient
  13. Explain how an IABP works
    • temporary balloon that is inserted through the aorta into the arch and is programmed to inflate during diastole which fills the coronary arteries and deflate during systole to decrease afterload
    • Systole: decreases afterload, decreases cardiac work, decreases myocardial oxygen consumption, increases cardiac output
    • Diastole: aucmentation of diastolic pressure, increases coronary perfusion
  14. What is PCI
    • Percutaneous coronary interventions
    • is a stent in the coronary artery establishing patency
  15. What is a CABG
    • Coronary Artery bipass graft
    • uses the internal mammary artery or saphenous vein to bypass coronary circulation and feed the heart
  16. What is an Impella device?
    Pump that runs from the ventricle to the aorta
  17. Which generally does better LV failure or mechanical complications
    LV failure
  18. What is a LVAD?
    Left ventricular assist device, pump that vaccumes out blood from the ventricle into the aorta
  19. you have a post MI patient with symptoms of confusion, lungs bibasialr rhales, no JVD, new high pitched holosystolic murmur at the 3rd and 4th intercostal space and an apical thrill, their extremities are ice cold. Their vitals are: Temp- 98.7, BP 68/40, HR 120, O2 sat- 97% What do you think is wrong with this patient?
    Post infarction ventricular septal defect
  20. Postinfarct VSD
    • uncommon, mostly due to a posterobasal septum or ami apical septum, ECHO best diagnostic test
    • IABP, dobutamine for acute stabilization100% mortality without surgery only 87% with surgery closure device
  21. a 73 year old female presents with acute respiratory failure, (batwing edema) her BP is 68/40 despite fluid her HR is 120, her O2 sat is 68% she is intubated her lungs have diffuse rhales, increased JVP a new holosystolic murmur no apical thrill and her extremities are ice cold what do you think this patient has?
    Acute Mitral regurgitation
  22. What is the treatment for Acute mitral regurgitation
    immediate repair or replacement with or without CABG ASAP surgical delay increases mortality
  23. Other than surgery how would you treat an acute mitral regurgitation patient
    • majority require mechanical ventilation
    • IABP, nitroprusside, dobutamine, LVAD, emergent coronary angiography
  24. You have a patient with an enlarged heart on CXR who presents with a BP of 68/40 and a HR of 120 O2 sat of 91% he is confused his lungs are clear he has increased JVP the heart sounds are not distant and there are no obvious murmurs the extremities are cool what do you suspect?
    • RV infarction
    • pulmonary embolism
    • Cardiac tamponade
    • constrictive pericarditis
  25. How would you manage a RV infarction?
    • Fluids to achieve PCWP of 15-18 mmHG
    • Dobutamine
    • IABP
    • Revascularization improve in hospital M and M
    • pRVAD
  26. What is you differential for an increased JVD with clear lungs
    • RV infarction
    • pulmonary embolism
    • tamponade
    • constrictive pericarditis
  27. What is your differential for new holosystolic murmur with no thrill
    Acute mitral regurgitation
  28. What is your differential for a new holosystolic murmur with apical thrill