cardiogenic shock
DESCRIPTION
cardiogenic shockTRANSCRIPT
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SOEPEL: 1
Presented by: Abdul Waris Khan
Rotation: Internal medicine
Cardiogenic shock
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SOEPEL
• Subjective:
• Chief complaint: 38-year-old female presented to ER with Severe
headache, SOB, dizziness, confusion, nausea, and palpitations.
• H/O presenting illness: The symptoms started 2 hours prior to the
admission to ER. She is a known case of HTN and a week ago was
diagnosed with MI.
No significant past medical or family history.
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• Objective:
• She was afebrile
• GCS of 12/15
• HR:100 beats/min (bpm)
• BP 176/117 mm Hg
• RR: 24
• Evaluation:
• coronary artery disease (CAD),
• pulmonary embolism (PE),
• subarachnoid hemorrhage,
• Takotsubo cardiomyopathy,
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• Plan
• ECG, CT, Echo, Cardiac enzymes, ABGs, V/Q scan
• Elaboration
• Resuscitate
• Oxygen
• Diamorphine
• Thrombolysis if MI
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• Learning goals:
Cardiogenic shock
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What is shock !!!!?
• Shock is the term used to describe acute circulatory
failure with inadequate or inappropriately distributed
tissue perfusion resulting in generalized cellular hypoxia
and/or an in ability of the cells to utilize oxygen.
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Definition
Cardiogenic shock (CS) is characterized by systemic hypoperfusion due to
severe depression of the cardiac index [<2.2 (L/min)/m2] and sustained
systolic arterial hypotension (<90 mmHg).
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Statistics
• CS is the leading cause of death of patients hospitalized with MI. Early reperfusion therapy
for acute MI decreases the incidence of CS.
• LV failure accounts for ~80% of the cases of CS complicating acute MI. Acute severe mitral
regurgitation (MR), ventricular septal rupture (VSR), predominant right ventricular (RV)
failure, and tamponade account for the remainder
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Causes
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Clinical presentation
Cardiogenic shock • Signs of myocardial failure, e.g.
• Raised jugular venous pressure (JVP)
• Pulsus alternans/paradoxus
• ‘Gallop’ rhythm,
• Basal crackles,
• Pulmonary oedema.
• Tachypnoea
• Tachycardia
• Cold/clammy extremities
• Drowsiness
• Confusion
• Oliguria
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Patient Profile
• In patients with acute MI, older age, female sex, prior MI, diabetes, and anterior MI location
are all associated with increased risk of CS.
• Reinfarction soon after MI increases the risk of CS.
• Two-thirds of patients with CS have flow-limiting stenoses in all three major coronary
arteries, and 20% have left main coronary artery stenosis.
• CS may rarely occur in the absence of significant stenosis, as seen in Takotsubo
cardiomyopathy, often in response to sudden severe emotional stress.
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Diagnosis
• If MI suspected:
• Echocardiography
• ECG
• Cardiac enzymes
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References
• Kumar and Clark clinical medicine 7th edition
• Davidson principals and practice of medicine 21st edition
• Harrison internal medicine 17th edition
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THANK YOU