Cardiogenic shock
Background
- Leading cause of death in pts w/ MI who reach the hospital alive
Work-Up
- Labs
- Troponin
- Lactate
- CBC
- Chem
- BNP
- <100 may rule-out cardiogenic shock
- ECG
- CXR
- TTE
Etiology
- Myocardial infarction
- Pump failure
- Mechanical complications
- Acute MR (papillary muscle rupture)
- VSD
- Free-wall rupture
- RV infarction
- Decreased contractility
- Sepsis
- Myocarditis
- Myocardial contusion
- Cardiomyopathy
- Mechanical obstruction to forward flow
- AS
- HOCM
- Mitral stenosis
- Pericardial
- LV regurgitation
- Chordal rupture
- Aortic insufficiency
DDX
- MI
- PE
- COPD exacerbation
- Peri/myocarditis
- Aortic dissection
- Pericardial tamponade
- Acute valvular insufficiency
- Sepsis
- Hemorrhage
- Toxins/drugs of abuse
Treatment
- General
- Airway
- Caution - PPV may worsen preload and CO
- Blood Pressure
- Fluid challenge
- Pressors
- Sys BP < 70: Dopamine or dopamine + dobutamine
- Sys BP > 70: Dobutamine or dobutamine + dopamine
- Dobutamine: 2–5 mcg/kg/min, up to 20mcg/kg/min
- Has potential vasodilation effect
- Dopamine: 3–5 mcg/kg/min, up to 50mcg/kg/min
- Dobutamine: 2–5 mcg/kg/min, up to 20mcg/kg/min
- Airway
- Specific
- Mitral Regurg
- Need to increase forward flow
- Dobutamine (contractility)
- Nitroprusside (afterload reduction)
- Need to increase forward flow
- MI
- PCI or thrombolysis
- Mitral Regurg
Source
Tintinalli