What Is Cardiogenic Shock?

Cardiogenic Shock
What is Cardiogenic Shock?

Cardiogenic shock is also sometimes called “pump failure”.
 Cardiogenic shock is a condition of diminished cardiac output that severely impairs

cardiac perfusion.
 It reflects severe left-sided heart failure.
Pathophysiology
This is what happens in cardiogenic shock:
1. Inability to contract. When the myocardium can’t contract sufficiently to maintain

adequate cardiac output, stroke volume decreases and the heart can’t eject an
adequate volume of blood with each contraction.
2. Pulmonary congestion.The blood backs up behind the weakened left ventricle,
increasing preload and causing pulmonary congestion.
3. Compensation. In addition, to compensate for the drop in stroke volume, the heart
rate increases in an attempt to maintain cardiac output.
4. Diminished stroke volume.As a result of the diminished stroke volume, coronary
artery perfusion and collateral blood flow is decreased.
5. Increased workload. All of these mechanisms increase the heart’s workload and
enhance left-sided heart failure.
6. End result. The result is myocardial hypoxia, further decreased cardiac output, and a
triggering of compensatory mechanisms to prevent decompensation and death.
Classification
The causes of cardiogenic shock are known as either coronary or non-coronary.
 Coronary. Coronary cardiogenic shock is more common than non coronary

cardiogenic shock and is seen most often in patients with acute myocardial infarction.
 Noncoronary. Noncoronary cardiogenic shock is related to conditions that stress the
myocardium as well as conditions that result in an ineffective myocardial function.
Statistics and Incidences

Cardiogenic shock could be fatal if left untreated.
 Cardiogenic shock occurs as a serious complication in 5% to 10% of patients

hospitalized with acute myocardial infarction.
 Historically, mortality for cardiogenic shock had been 80% to 90%, but recent studies
indicate that the rate has dropped to 56% to 67% due to the advent of thrombolytics,
improved interventional procedures, and better therapies.
 Incidence of cardiogenic shock is more common in men than in women because of
their higher incidence of coronary artery disease.
Causes
Cardiogenic shock can result from any condition that causes significant left ventricular
dysfunction with reduced cardiac output.
 Myocardial infarction (MI).Regardless of the underlying cause, left ventricular

dysfunction sets in motion a series of compensatory mechanisms that attempt to
increase cardiac output, but later on leads to deterioration.
 Myocardial ischemia. Compensatory mechanisms may initially stabilize the patient
but later on would cause deterioration with the rising demands of oxygen of the
already compromised myocardium.
 End-stage cardiomyopathy.The inability of the heart to pump enough blood for the
systems causes cardiogenic shock.
Clinical Manifestations
Cardiogenic shock produces symptoms of poor tissue perfusion.
 Clammy skin. The patient experiences cool, clammy skin as the blood could not
circulate properly to the peripheries.
 Decreased systolic blood pressure.The systolic blood pressure decreases to 30
mmHg below baseline.
 Tachycardia. Tachycardia occurs because the heart pumps faster than normal to
compensate for the decreased output all over the body.
 Rapid respirations. The patient experiences rapid, shallow respirations because there
is not enough oxygen circulating in the body.
 Oliguria. An output of less than 20ml/hour is indicative of oliguria.
 Mental confusion. Insufficient oxygenated blood in the brain could gradually cause
mental confusion and obtundation.
 Cyanosis. Cyanosis occurs because there is insufficient oxygenated blood that is being
distributed to all body systems.
Assessment and Diagnostic Findings

Diagnosis of cardiogenic shock may include the following diagnostic tests:
 Auscultation. Auscultation may detect gallop rhythm, faint heart sounds and, possibly,
if the shock results from rupture of the ventricular septum or papillary muscles, a
holosystolic murmur.
 Pulmonary artery pressure (PAP).PAP monitoring may show increase in PAP,
reflecting a rise in left ventricular end-diastolic pressure and increased resistance to the
afterload.
 Arterial pressure monitoring. Invasive arterial pressure monitoring may indicate
hypotension due to impaired ventricular ejection.
 ABG analysis. Arterial blood gas analysis may show metabolic acidosis and hypoxia.
 Electrocardiography. Electrocardiography may show possible evidence of acute MI,
ischemia, or ventricular aneurysm.
 Echocardiography. Echocardiography can determine left ventricular function and
reveal valvular abnormalities.
 Enzyme levels. Enzyme levels such as lactic dehydrogenase, creatine kinase. Aspartate
aminotransferase and alanine aminotransferase may confirm MI.
Medical Management
The aim of treatment is to enhance cardiovascular status by:
 Oxygen. Oxygen is prescribed to minimize damage to muscles and organs.
 Angioplasty and stenting. A catheter is inserted into the blocked artery to open it up.
 Balloon pump. A balloon pump is inserted into the aorta to help blood flow and
reduce workload of the heart.
 Pain control. In a patient that experiences chest pain, IV morphine is administered for
pain relief.
 Hemodynamic monitoring.An arterial line is inserted to enable accurate and
continuous monitoring of BP and provides a port from which to obtain frequent
arterial blood samples.
 Fluid therapy.Administration of fluids must be monitored closely to detect signs of
fluid overload.

What Is Cardiogenic Shock?

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Cardiogenic Shock

What is Cardiogenic Shock?

 Cardiogenic shock is a condition of diminished cardiac output that severely impairs

1. Inability to contract. When the myocardium can’t contract sufficiently to maintain

 Coronary. Coronary cardiogenic shock is more common than non coronary

Statistics and Incidences

 Cardiogenic shock occurs as a serious complication in 5% to 10% of patients

 Myocardial infarction (MI).Regardless of the underlying cause, left ventricular

Assessment and Diagnostic Findings

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