Background cardiogenic shock cs is a multifactorial, hemodynamically complex syndrome associated with high mortality. A smaller infarct may also originate this condition in a patient with a previously compromised ventricle function. Ppt cardiogenic shock powerpoint presentation free to. View and download powerpoint presentations on cardiogenic shock pharmacological management ppt. Despite advances in reperfusion and mechanical circulatory support, management remains highly variable and outcomes poor. Cardiogenic shock is an acute state of decreased cardiac output resulting in inadequate tissue perfusion despite adequate circulating volume. Scientific statements and publications have recommended the use of vasoconstrictors as the firstline pharmacologic choice for most cases of cardiogenic shock cs, without the abundance of strong clinical evidence. Cardiogenic shock and pulmonary edema harrisons principles. Arguably, the single most important historical advancement was the shock should we emergently revascularize occluded coronaries for cardiogenic shock. Cardiogenic shock cs is defined as persistent hypotension and tissue hypoperfusion due to cardiac dysfunction in the presence of adequate intravascular volume and left ventricular filling pressure. Nutrition, mobilization, prophylaxis against dvtulcers 6.
Although cardiogenic shock is not common, it does complicate 710% of patients with stemi and 3% of nstemis. Types cardiogenic shock associated with cardiac pathology hypovolemic shock caused by inadequate blood volume anaphylactic shock caused by allergic reaction septic shock associated with infections neurogenic shock caused by damage to the nervous system metabolic associated with metabolic acidosis, hypothyroidism, addisonian crisis. The randomized impella versus iabp reduces mortality in stemi patients treated with primary pci in severe cardiogenic shock impress in severe shock should we emergently. This damage prevents the hearts main pumping chamber, the left ventricle from working well. Recent research has suggested that the peripheral vasculature and neurohormonal and cytokine systems play a role in the pathogenesis and persistence of cs. Cardiogenic shock cs is a common cause of mortality, and management remains. It is a frequently fatal complication of a variety of disorders, occurring most commonly following acute myocardial infarction. This leads to acute hypoperfusion and hypoxia of the tissues and organs, despite the presence of an adequate intravascular volume.
If necessary, youll be connected to a breathing machine ventilator. Additionally, the mortality is greater than 50% goldberg 1999. Cardiogenic shock cs is characterized by systemic hypoperfusion due to severe depression of the cardiac index 18 mmhg. Treatment recommendations are specific to patient groups. The thickness of the arrows schematically represents the strength of the linkage depending on the severity and duration of the disorder and on the patients physiologic reserve. Ppt cardiogenic shock powerpoint presentation free to download id. Youll receive medications and fluid through an intravenous iv line in. Definition cardiogenic shock is a state of endorgan hypoperfusion due to cardiac failure pulmonary artery pa catheterization. Unfortunately, there has been little progress in reducing time to hospital presentation over the past decade, 4 and this perhaps accounts for the stagnant incidence of cardiogenic shock in community studies 7.
Cardiogenic shock cs is a common cause of mortality, and management remains challenging despite advances in therapeutic options. Find powerpoint presentations and slides using the power of, find free presentations research about cardiogenic shock pharmacological management ppt. This complication occurred in the early postoperative period and reversed immediately after treatment with intravenous verapamil. These patients should be treated with aggressive medical therapy and be evaluated.
Cardiogenic shock cs remains the most common cause of death in patients admitted with acute myocardial infarction ami and mortality remained nearly unchanged in the range of 4050% during the last two decades. This can done in a number of waysfluid resuscitation, blood transfusions, vasopressors, and ionotropes. In this lesson we will have cardiogenic shock explained full so you have a. Cs is caused by severe impairment of myocardial performance that results in diminished cardiac output, end. The most common insult for cardiogenic shock is left ventricular pump failure in the setting of acute myocardial infarction. Management of cardiogenic shock european heart journal. One challenge of guidelines is that the way recommendations are stated can potentially lead to oversimplification of complex situations. Cardiogenic shock is a condition of inadequate tissue perfusion due to decreased cardiac output. Find powerpoint presentations and slides using the power of, find free presentations research about shock types of shock ppt.
Fredric ginsberg, md assistant professor of medicine, robert wood johnson medical school university of medicine and dentistry of new jersey joseph e. Cardiogenic shock united states pdf ppt case reports. Hemodynamic findings in cardiogenic shock include a reduced cardiac output without evidence of hypovolemia. Acute myocardial infarction mi is the leading cause, but other potential etiologic factors need to be considered. Cardiogenic shock backgroundpatient presentation cyanotic and. During this treatment, which most people who have cardiogenic shock need, youre given extra oxygen to breathe, to minimize damage to your muscles and organs. A 62 yrs old male is brought to the ed with sudden onset chest pain, exessive sweating, nausea and dyspnoea no other medical history is known. The fundamental problem in cardiogenic shock is the inability of the heart to pump adequate amounts of blood to vital organs.
The extent of myocardial salvage from reperfusion treatment decreases exponentially with time to reestablishing coronary flow. Cardiogenic shock develops as a result of the failure of the heart in its function as a pump, resulting in inadequate cardiac output. Cardiogenic shock is characterized by both systolic and diastolic dysfunction decreased coronary perfusion pressure and increased myocardial oxygen demand play a. It is most likely that the next gamechanger in the treatment of cardiogenic shock is going to be timely initiation of powerful mechanical circulatory support. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Cardiogenic shock is rare, but its often fatal if not treated immediately. Cardiogenic shock journal of the american heart association. He is agitated upon presentation and is unable to give any history. Jul 23, 2015 cardiogenic shock occurs when there is failure of the pump action of the heart, resulting in a decrease in cardiac output causing reduced endorgan perfusion.
Pathophysiology and representative case presentation. Cardiogenic shock is the leading cause of inhospital death in patients with acute myocardial infarction ami. The condition is most often caused by a severe heart attack. Cardiogenic shock in patients with acute coronary syndromes. Cardiogenic shock cs a state of endorgan hypoperfusion due to cardiac failure zevidence of hypoperfusion zcold clammy skin feethand zcloudy consciousness zoliguria zsystolic bp cardiogenic shock. Prev view hires image download powerpoint slide next. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock. Objectives this study investigated whether a standardized teambased approach can improve outcomes in cs and whether a risk score can guide clinical. Cardiogenic shock can be a major and frequently fatal, complication of both acute and chronic disorders that aaect the function of heart to maintain adequate tissue perfusion. Oneills presentation on abiomeds impella quality assurance program and the importance of treatment protocols to improve patient survival and heart recovery.
Cardiogenic shock cs is the most important cause of death in patients admitted with acute myocardial infarction. The choice of patients for and results of circulatory support using the intraaortic balloon pump followed by early cardiac surgery are presented. Cardiogenic shock occurs when a suddenly weakened heart usually weakened from a heart attack cant supply the body with the needed amount of blood and oxygen. Norepinephrine as a firstline inopressor in cardiogenic shock. The pathophysiology of cs is incompletely understood but limited clinical trial experience suggests that early and robust support of the failing heart to allow for restoration of systemic homoeostasis appears. The definition, pathophysiology, and diagnosis of cardiogenic shock are presented. Noorekhuda md final part student cardiology,dmch 2. View and download powerpoint presentations on shock types of shock ppt. Learn about its causes, treatment, outcome and more from cleveland clinic. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Treatment of cardiogenic shock depends on the cause with the initial goals to improve blood flow to the body.
Acute myocardial infarction mi with left ventricular lv dysfunction is the most frequent cause of cs. Cs occurs in 58% of amis, with 2% of cs more than onequarter of the total being present at the time of admission. Management of cardiogenic shock complicating myocardial. Scribd is the worlds largest social reading and publishing site. Its management is detailed, including specific forms of therapy for the various subgroups of patients in whom cardiogenic shock is an integral part. Youll receive medications and fluid through an intravenous iv line in your arm. Early revascularization, vasopressors and inotropes, fluids, mechanical circulatory support, and general intensive care measures. It usually takes a considerable area of infarcted myocardium around 40% to lead to cardiogenic shock. Tilarginine acetate injection in a randomized international study in unstable acute myocardial infarction patients with cardiogenic shock triumph powerpoint ppt. Reconsidering vasopressors for cardiogenic shock chest. For the 4th lesson in our series on shock we take a good look at cardiogenic shock.
Parrillo, md professor of medicine, robert wood johnson medical school university of medicine and dentistry of new jersey head, division of cardiovascular disease and critical care medicine director, cooper. Cardiogenic v v septic v or v prevalence occurs in 58% of stemi and 2. Share the scai shock classification system with your colleagues using these teaching slides designed for easy dissemination. Doppler echocardiography used to confirm elevation of lv filling pressures circulation. Cardiogenic shock cs remains the leading cause of death in acute myocardial infarction ami, despite improvements in the treatment of ami and cs in the past decade. Cardiogenic shock is an extremely morbid condition. View and download powerpoint presentations on hypovolemic shock ppt. Presentation slides powerpoint presentation slides pdf bedside checklist download pdf validation studies.
It is associated with inhospital mortality rates 50%. Revascularization strategies in cardiogenic shock patients. Download the stages of cardiogenic shock fact sheet download the scai shock pyramid teaching slides. Cardiogenic shock cs and pulmonary edema are lifethreatening high acuity conditions that require treatment as medical emergencies, usually in an intensive care unit icu or cardiac intensive care unit cicu. Almost no one survived cardiogenic shock in the past. Cardiogenic shock treatment focuses on minimizing the damage from lack of oxygen to your heart muscle and other organs. Parrillo, md professor of medicine, robert wood johnson medical school university of medicine and dentistry of new jersey head, division of cardiovascular disease and critical care medicine director, cooper heart institute. Find powerpoint presentations and slides using the power of, find free presentations research about hypovolemic shock ppt. If treated immediately, about half the people who develop the condition survive. Cardiogenic shock cs is a clinical condition of inadequate tissueend organ perfusion due to cardiac dysfunction hypotension sbp may 26, 2016 cardiogenic shock 1. Cardiogenic shock is a condition in which your heart suddenly cant pump enough blood to meet your bodys needs. Mar 21, 2017 download the detroit cardiogenic shock initiative treatment algorithm.
Cardiogenic shock diagnosis and treatment mayo clinic. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Even after narrowing the diagnosis to cardiogenic shock, the list of possible etiologies is vast and the cause important to determine because the source of the shock will respond differently to different treatments. Department of cardiology current management issues of cardiogenic shock gopal c ghosh unit1. Cardiogenic shock cs is a high acuity, complex, and hemodynamically diverse state of endorgan hypoperfusion that is associated with multisystem organ failure. Remove this presentation flag as inappropriate i dont like this i like this remember as a favorite. A free powerpoint ppt presentation displayed as a flash slide show on id.
Cardiogenic shok some notes develops in 10% to 20% of patients hospitalized ami mortality of such patients approximately 80% or higher very few patients develop shock immediately after ami about half of the patients develop shock within 24h pathology clinical signs ecg shows the pattern of ami or acute coronary insufficiency the sbp treatment, nearly 50% of patients with cardiogenic shock still do not survive to hospital discharge. The most common cause of cardiogenic shock is damage to the heart muscle from a severe heart attack. Chart and diagram slides for powerpoint beautifully designed chart and diagram s for powerpoint with visually stunning graphics and animation effects. Cardiogenic shock advanced hf cardiogenic shock the role of the cardiac intensivist 1. Objectives introduction cardiogenic shock definition symptoms causes clinical manifestation diagnosis treatment. Today, half of the people who experience cardiogenic shock survive with prompt treatment. Cardiogenic shock complicating ami occurs in the range from 5 to 15%. Standardized teambased care for cardiogenic shock jacc. Treatment is to assure adequate right sided filling pressure and adequate lv preload. While acute myocardial infarction ami is the major cause of cardiogenic shock, other diagnostic considerations should always be entertained. Management of cardiogenic shock complicating acute. Em in 5 blog is a series of 5 minute emergency medicine lectures on high yield topics. Management of cardiogenic shock dr noor e khuda topu,md thesis part.
Management of cardiogenic shock complicating acute coronary. Cardiogenic shock cs is a complex and highly morbid entity conceptualised as a vicious cycle of injury, cardiac and systemic decompensation, and further injury and decompensation. Despite recent advances in treatment, nearly 50% of patients with cardiogenic shock still do not survive to hospital discharge. Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. Sites participating in the national cardiogenic shock initiative csi have adopted the national csi algorithm as the foundatio. Sepsisinfectious issues prevention and management 5. Pediatric cardiogenic shock is an often insidious phenomenon with presentations requiring a broad differential diagnosis. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Please note that formulationsroutes and doses may differ between drug names and brands, drug formularies, or locations. Cardiogenic shock is the syndrome that ensues when the heart is unable to deliver enough blood to maintain adequate tissue perfusion. Refractory cardiogenic shock, with tissue hypoperfusion despite vasoactive medications and treatment of the underlying cause, is associated with inhospital mortality rates ranging from 30% to 50%. Department of cardiology current management issues of cardiogenic shock gopal c ghosh unit1 2.
Looking to realworld evidence in cardiogenic shock dr. If cardiogenic shock is due to a heart attack, attempts to open the hearts arteries may help. The extent of ischaemic myocardium has a profound impact on the initial, inhospital, and postdischarge management and prognosis of the cardiogenic shock patient. A 65yearold man with longstanding hypertension developed cardiogenic shock due to the onset of left ventricular outflow obstruction and severe mitral regurgitation after surgical repair for abdominal aortic aneurysm. Our new crystalgraphics chart and diagram slides for powerpoint is a collection of over impressively designed datadriven chart and editable diagram s guaranteed to impress any audience. Causes of cardiogenic shock immediate causes cardiogenic shock occurs if the heart suddenly cant pump enough oxygenrich blood to the body. Cardiogenic shok some notes develops in 10% to 20% of patients hospitalized ami mortality of such patients approximately 80% or higher very few patients develop shock immediately after ami about half of the patients develop shock within 24h pathology clinical signs ecg shows the pattern of ami or acute coronary insufficiency the sbp cardiogenic shock immediate causes cardiogenic shock occurs if the heart suddenly cant pump enough oxygenrich blood to the body. Most people who have cardiogenic shock need extra oxygen. One of the treatment is to increase the vascular resistance,but it will add up the afterload of the heart,which means the blood will flow slowly.