Download presentation
Presentation is loading. Please wait.
1
CARDIOGENIC SHOCK University of Medicine and Pharmacy, Iasi
School of Medicine ANESTHESIA and INTENSIVE CARE Conf. Dr. Ioana Grigoras MEDICINE 4th year English Program Suport de curs CARDIOGENIC SHOCK
2
CARDIOGENIC SHOCK Definition Etiology Pathophysiology Clinical signs
Monitoring Positive şi etiological diagnosis Differential diagnosis Principles of treatment
3
DEFINITION = clinical syndrome caused by an acute disturbance of heart
function, which results in reduction of systemic blood pressure and tissue hypoperfusion with consecutive dysfunction of systems and organs. = systemic BP< 90mmHg or mean BP< cu 30mmHg compared with basic values IC < 2,2l/min m2 PCPB > 15mmHg
4
ETIOLOGY Decreased myocardial contractility
Myocardial infarction Cardiomiopathy Drugs, metabolic/electrolytic/acid-base disturbances, post-extracorporeal circulation Ventricular outflow obstruction Aortic stenosis Hypertrofic subvalvular aortic stenosis Ventricular filling disturbances Mitral stenosis Atrial myxoma Valvular dysfunction Acute mitral regurgitation Acute tricuspid regurgitation Cardiac dysrhytmias Tachyarrhytmias Bradyarrhytmias Cardiac rupture Chest trauma
5
PATHOPHYSIOLOGY myocardial ischemia ± necrosis → LV, RV, both Systolic myocardial dysfunction→ contractility → cardiac output→ Cardiac Index → systemic BP Diastolic myocardial dysfunction → LV compliance→ ↑ LVTDP → ↑ retrograde pressure → ↑ PCPB → pulmonary congestion→ hypoxemia Neuro-vegetative response→↑sympatic stimulation +↑ cortisol, ADH + ↑ SRAA → peripheral vasoconstriction → oliguria + metabolic acidosis compensatory effects decompensatory effects vicious circles = death spiral
6
PATHOPHYSIOLOGY
7
CLINICAL SIGNS Arterial hypotension Signs of tissue hypoperfusion
Signs of pulmonary congestion altered mental status Cyanosis, cold extremities, profuse sweating Hypotension, low pulse amplitude Tachypnea, dyspnea,pulmonary rales , turgescent jugular veins Tachycardia, arrhythmias (brady-/tachyarrhytmias),heart murmurs or overlapping heart sounds Oliguria
8
MONITORING clinical signs SpO2 invasive BP ECG CVP
mental status, skin temperature and colour SpO2 invasive BP ECG CVP other hemodynamic parameters pulmonary artery pressure, PCPB, RVS, RVP, DC, SvO2 echocardiography urinary output pH + blood gas analysis function of organ and systems renal, liver, coagulation tests, electrolytes, Hb, Ht, WBC count, bllod glucose
9
MONITORING
10
MONITORING
11
MONITORING
12
MONITORING
13
MONITORING
14
MONITORING
15
MONITORING clinical signs SpO2 invasive BP ECG CVP
mental status, skin temperature and colour SpO2 invasive BP ECG CVP other hemodynamic parameters pulmonary artery pressure, PCPB, RVS, RVP, DC, SvO2 echocardiography urinary output pH + blood gas analysis function of organ and systems renal, liver, coagulation tests, electrolytes, Hb, Ht, WBC count, bllod glucose
16
DIAGNOSIS positive diagnosis clinical signs etiological diagnosis ECG
hemodynamic parametres etiological diagnosis ECG Hemodynamic parameters Myocardial enzymes Echocardiography others investigations
17
DIFFERENTIAL DIAGNOSIS
HR BP CO CVP PAOP SVR Da-vO2 SvO2 Hypovolemic shock ↑ Cardiogenic shock septic shock ↑ N N N
18
ABBREVIATIONS: HR – heart rate BP – arterial blood pressure
CO – cardiac output CVP –central venous pressure PAOP – pulmonary artery occlusion pressure SVR – systemic vascular resistance Da-v O2 – oxygen arterial-venous difference SvO2 – mixed venous blood oxygen saturation
19
PRINCIPLES OF TREATMENT
early and aggresive treatment – save time Save functional myocardium improvement of the myocardial oxygen supply/demand balance Save ischemic myocardium Myocardial reperfusion
20
PRINCIPLES OF TREATMENT
Improvement of the myocardial oxygen supply -demand relationship ↑ myocardial oxygen supply Correction of hypoxemia – O2 therapy, ventilatory support (CPAP, PEEP) Correction of hypotension – volemic therapy vasoconstrictors Improvement of cardiac output - inotropic agents myocardial oxygen demand Treatment of pain – opioids, analgesics Treatment of cardiac dysrhythmias – cardioversion antiarrhytmic agents pacing Other means of hemodynamic support Intraaortic ballon counterpulsation Mechanical ventricular assist devices
21
PRINCIPLES OF TREATMENT
22
PRINCIPLES OF TREATMENT
myocardial reperfusion Thrombolysis PTCA Cardiac surgery: emergency coronary artery by-pass correction of mechanical defects cardiac transplant
23
CONCLUSIONS Cardiogenic shock is most frequently, the consequence of acute myocardial infarction Mortality is high (40-80%) The clinical picture consists of arterial hypotension, signs of tissue hypoperfusion and signs of pulmonary congestion Invasive hemodynamic monitoring is essential for diagnosis and guidance of treatment Early start of treatment and early myocardial reperfusion – improved chances of survival Early PTCA - the treatment of choice.
Similar presentations
