Let’s Talk About Cardiogenic Shock

What are the hallmark signs of a patient going into cardiogenic shock?

• Decreased Cardicac Output
• Increased Preload
• Increased Afterload

Essentially, your patient’s heart is not pumping very well!  They end up with increased preload and afterload without great cardiac squeeze, pumping against a wall of pressure!  This leads to decreased organ perfusion which is very serious.  The mortality is 40 – 60%!

What do their hemodynamics look like?

• ↓ CI < 2.0 L/min/m²
• ↑ SVR (afterload)
  • > 1200 dynes/sec/cm^-5
• ↑ RAP/CVP (preload)
• PAOP > 14 mm Hg
• ↓ SvO₂
  • SvO₂ < 60 – 65%

What are the clinical signs?

• Hypotension (MAP < 60 – 65)
• Tachycardia
• S₃, pulmonary edema
• Crackles
• Dysrhythmias
• ↓ perfusion
• Poor capillary refill
• Skin &/or knee mottling
• ↓ UOP
  • Oliguria < 0.5 mL/kg/hour

What do you do for your patients?

Supportive Treatment:

• **Mechanical circulatory support (i.e.  IABP, Impella)
  • Cardiac Power Output (CPO) to guide LV support with MCS
  • PAPi for RV support
• Vasopressors/ + Inotrope
• Diuretics (as perfusion allows)
• Afterload reduction / venous vasodilators (i.e. NTG)

If you want more information about cardiogenic shock, consider getting certified in Cardiac Medicine and taking Nicole’s Cardiac Medicine Course! This course is 30% off until November 11th at midnight. The course offers 8 CE credits and covers the following fundamental cardiac topics:

• Hemodynamics
• Acute Coronary Syndromes
• Heart Failure
• Valvular Disease
• Arrhythmias 

Nicole also offers a great Cardiac Boot Camp Course that is an excellent course to boost your cardiac skills and knowledge. 

If you want to boost your overall Critical Care knowledge, check out Nicole’s awesome and comprehensive Critical Care Survival Guide!

References:

Cardiogenic Shock: Practice Essentials, Background, Pathophysiology

Clinical manifestations and diagnosis of cardiogenic shock in acute myocardial infarction – UpToDate

Treatment and prognosis of cardiogenic shock complicating acute myocardial infarction – UpToDate