Cardiogenic shock- Introduction
- Cardiogenic shock is due to inadequate pumping action of heart
- Cardiogenic shock occurs when 40% or more of the left ventricle is destroyed.
- Cardiogenic shock by definition represents a more severe form of cardiac failure resulting in decreased organ perfusion in addition to conventional features of pulmonary congestion and left ventricular dysfunction.
- Cardiac failure with hypoperfusion and that regarded as cardiogenic shock differ only in the severity of hypoperfusion.
Characteristics of cardiogenic shock are ?
- Evidence of organ hypoperfusion with cold, clammy skin especially on the feet and hands that may be associated with peripheral cyanosis of nail beds.
- Oliguria, disordered mentation
- Systolic blood pressure < 80 to 90 mm Hg
- Urine output < 300 m1/24hr.
- Left ventricular end-diastolic pressure or more commonly pulmonary capillary wedge pressure > 18 mm Hg.
- Evidence of a primary cardiac abnormality.
- Cardiac index not > 1.8 L/min per square meter of body surface.
- Drugs used in cardiogenic shock are → Dobutamine, Dopexamine or dopamine.
- It is indicated for the management of cardiogenic shock and any circulatory shock syndrome associated with systemic vasodilation (e.g., septic shock).
- The drug is particularly valuable for its ability (in intermediate-to-high dose rates) to promote vasoconstriction while preserving the cardiac stroke output.
- Low-dose dopamine is also used to preserve renal blood flow and to promote urine output in patients with oliguric acute renal failure, or in those at risk for oliguric renal failure.
- Although dopamine does not improve intrinsic renal function in this situation, it can promote urine output and limit fluid retention.
- It is the preferred inotropic agent for the acute management of low output states due to systolic heart failure.
- Because dobutamine does not usually raise the arterial blood pressure, it is not indicated as monotherapy in patients with cardiogenic shock.
- In cardiacshock BP < 90 mm of Hg
- Drug of choice for cardiogenic shock is Dopamine
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