Cardiogenic Shock

Question: What is the difference between Heart Faliure and Cardiogenic Shock? By definition, shock is a state in which the perfusion is not adequate to maintain the metabolic needs of the bodys cells, if the underlying disease affects the myocardium then the condition is called cardiogenic shock since it is cardiogenic in origin. Heart faliure is defined in my USMLE book as "inability of the heart to maintain an adequate output to meet the body's metabolic needs" What is the difference between the two?

Answer: The main thing would be the timeframe in which they occur. Heart failure is usually over a long period of time, like if someone has uncontrolled high blood pressure, their heart is working hard to push the blood around the body. After years of this, it becomes weaker and weaker. This can happen from fluid overload, high blood pressure, drugs, and many other things. Cardiogenic shock is something that happens over a short period of time. The heart is put into shock by some sort of trauma, like from an arrhythmia or heart attack. Another big difference is some of their causes. Just look up each in wikipedia and you'll find a lot of info on them.

Question: What is the difference between cardiogenic shock and neurogenic shock? How they relate to renal failure? Thank you for your help.

Answer: Cardiogenic shock is a disease state where the heart is damaged enough that it is unable to supply sufficient blood to the body. Neurogenic shock, sometimes called vasogenic shock, results from the disruption of autonomic nervous system control over vasoconstriction. Under normal conditions, the autonomic nervous system keeps the muscles of the veins and arteries partially contracted. At the onset of most forms of shock, further constriction is signaled. However, the vascular muscles cannot maintain this contraction indefinitely. A number of factors, including increased fluid loss, central nervous system trauma, or emotional shock, can override the autonomic nervous system control. The veins and arteries immediately dilate, drastically expanding the volume of the circulatory system, with a corresponding reduction of blood pressure. Any shock that lasts long enough can cause Acute renal failure. But because of the origin and pathology cardiogenic shock is most often associated with renal failure.

Question: What is the estimated incident of cardiogenic shock after miocardio infarction? Percentage wise, please.

Answer: According to the New England Journal of Medicine, the incidence of cardiogenic shock complicating acute myocardial infarction is 7.5 percent. The authors also found that the average incidence has remained very steady over time, neither increasing nor decreasing in percentage.

Question: What happens to Pulmonary capillary wedge pressure in Cardiogenic and Hypovolemic shock? In wich increases or decreases and why?

Answer: It would decrease. If there is a reduction in blood volume going through the systemic circulation, less blood will go to the right side of the heart, and so less blood will flow into the pulmonary arteries, and so pulmonary capillary wedge pressure will decrease. Hope that helps, email me any questions Ashley

Question: Health Care Professionals Only: concern about code IV compatibility and cardiogenic shock question? the patient is likely on some IV fluids infusing when code blue is called. Is it wise/good practice to unhook everything such as TPN, other IV meds infusing~~~before the code team arrives? Is there a protocolfor compatibility of IV meds pushed specifially for Code Blue situations? Or does it stand that during an emergency, we don't alcohol swipe port, take concern with compatibility, etc? If you can clarify this... Also, if the patient had seized, does this qualify as cardiogenic shock.. When should the pt be put in Trendelenburg position to help shunt blood to heart? Before the code team arrives? Is this even done at all if you need to do rescusitation? Thanks Lorenzo for addressing my questions/concerns. I do realize seizures do not exactly = cardiogenic shock, but I was interesting in knowing if seizures can lead to cardiogenic shock, in which there definitely is pump failure... I appreciate the reply,,,

Answer: When trying to resuscitate during a code, we need a good IV line. If there are a bunch of things on a pump, and you're not getting in anyone's way, unhook them and get the spaghetti of lines out of the way. Hang a bag of plain normal saline - it's good for flushing code meds in. During a code, the drugs have to be pushed QUICKLY. A second to wipe off a port won't hurt, but it is important not to cause delays. Seizures and cardiogenic shock are not usually related, although a patient may have both for different reasons. As Lorenzo said, ABC is what we do: Airway (that's where I come in!), Breathing then Circulation. Tberg is a good idea if the patient is in full arrest to avoid aspiration of gastric contents, if nothing else. You have to know the patient, though. You wouldn't want to put someone with increased intracranial pressure in steep Tberg. In just about every hospital I've been in, as soon as the code is called, the patient's room is so full of people that there's hardly room to move. Unless you know what you're supposed to do, the best thing is to get out of the way and listen to see if you can go fetch something, or provide information that the doctors need.

Question: doing CPR on someone that still has a pulse, can it cause cardiogenic shock?

Answer: Just FYI- as of 2006, the ECC guidelines for CPR as followed by the Red Cross and Heart Association allow us to do CPR on people with a pulse. You should take a current CPR class for the full details, but briefly, because most people mess up the pulse and most adults who stop breathing need CPR, we no longer check for a pulse on an adult victim.

Question: what the investigation for cardiogenic shock?

Answer: Cardiogenic shock is diagnosed with the insertion of a swan-ganz cathetor. It measures the hearts cardiac output and pressures within chambers of the heart, and the forces the heart is pumping against. In can also diagnose .pressure in the lungs. Other tests would be an ecg,chest x-ray, echo, coronary angiogram, foley cathetor, arterial line,arterial blood gases blood work,. oxygen saturation monitor,measurement of cardiac ouput and determining peripheral vascular resistance.. Most important, a good physical examination and a good history.

Question: shock mcq step 1 need confirmation on answer choice please? A 82–year-old diabetic is involved in an automobile accident, with severe thoracic and abdominal traumatic injuries. He is rushed to the hospital and placed in the intensive care unit. After a few hours, there is the rapid onset of myocardial dysfunction, hypotension, disseminated intravascular coagulation, and coma. This sequence of events most closely mimics what type of shock? A. Anaphylactic B. Cardiogenic C. Hypovolemic D. Neurogenic E. Septic is this E due to disseminated intravascular coagulation?

Answer: Yeah, I think so. It's not A or D (no head injury). It's not primarily cardiogenic (B), because they don't describe symptoms of heart failure. Hypovolemic shock wouldn't cause DIC (or probably even myocardial dysfunction). I'd go with E.

Question: A cardiogenic Question? Heath professional please? Which of the following conditions is not a potential cause of cardiogenic shock? A. Tension pneumothorax B. Spinal cord injury C. Tamponade D. Cardiac arrhythmias

Answer: B. Spinal cord injury would be the most appropriate answer.

Question: What drugs do you use to treat the following types of shock? (I mean specifically inotropes/drugs pls) - Hypovolemic = replace volume/electolytes, then? - Cardiogenic = which inotropes/chromotropes? - Septic = Antobiotic + supportive measurements then what inotropes/etc favored? - Anaphylactic = Adrenaline infusion then? Spinal = What is the treatment / drugs? Thanks

Answer: (1) for cardiogenic and hypovolomic shock normal saline and atropine- Medicines such as dopamine, dobutamine, epinephrine, and norepinephrine may be needed to increase blood pressure and the amount of blood pumped out of the heart (cardiac output). (2)for septi shock * Drugs to treat low blood pressure, infection, or blood clotting which haparine,flucloxaciline, epinephrine. * Fluids by a vein (intravenously) * Oxygen * Surgery * Support for any poorly functioning organs for anaphlactic shock Mild cutaneous reaction will respond to intravenous or L M. adrenaline, 0. 5 ml 1: 1000 and to antihistamine. Adrenaline, 0.5 ml 1:1000 intravenously also can be injected in remote areas (outreach of the medical facilities) by a special pen Hydro cortisone, 500 mg, intravenously Aminophylline 500 mgs IN. 6 hourly