Cardiogenic Shock

Yosi Oktarina, S.Kep., Ns., M.Kep

Description of Cardiogenic Shock

Cardiogenic shock results from failure of the heart (Rt.

ventricle, or left ventricle, or both) to effectively pump blood

forward.
The outcome of pump failure is decreased tissue perfusion and
circulatory failure.
Mortality rate is very high (50-75%), if not treated
immediately

Etiology and Pathophysiology of Cardiogenic Shock

Etiology: Cardiogenic shock can result from primary

ventricular ischemia most commonly caused by acute MI and

structural problems such as congestive heart failure,
intracardiac tumor, acute myocarditits, Hemorrhage, and
prolonged septic shock. Other conditions that may cause
cardiogenic shock are bradydysrhytmias and
tachydysrhythmias.

ETIOLOGY FACTORS

Pathophysiology of Cardiogenic Shock

Pathophysiology: Impaired ability of the ventricle to pump

blood forward, leads to decreased stroke volume (SV) and an

increase in the blood in the left ventricle at the end of the
systole. A decrease in the SV results in a decrease in cardiac
output (CO) which is responsible for decreased oxygen supply
and ineffective tissue perfusion.

As left ventricular contractility declines and ventricular

compliances decreases, an increase in end-systolic volume

results in blood backing up into the pulmonary edema.
Pulmonary edema causes impaired gas exchange and decreased
oxygenation of the arterial blood, which further impair tissue
perfusion.

PATHWAY OF CARDIOGENIC SHOCK

Clinical Manifestations of Cardiogenic Shock

SBP <90 mm Hg.
Acute drop in blood pressure > 30 mm Hg.
HR > 100 bpm.
Weak, thready pulse.
Diminished heart sounds.
Change in sensorium.
Cool, pale , moist skin.
Urine output < 30 mL/hr.
Chest pain.
Dysrhythmias and tachypneas.
Decreased cardiac output.
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Medical Management

 Correction of underlying cause:

Correction of the underlying cause is very important as it
may lead to:
- Fail of the compensatory mechanisms
- It can reduce the effectiveness of the interventions
Correction of:
- Dysrhythmia
- Acidosis & electrolyte disturbances

 Initiation of first line treatment:

Oxygenation- Nasal cannula @ 2-6 lpm

Hemodynamic Monitoring- BP
Fluid Therapy- RL, NS, Dextran
Pain Control- Morphine

Pharmacological Management:

Dobutamine
Nitroglycerine (Vasodilator)
Dopamine
Vasoactive Medications
> Epinephrine
> Nor- Epinephrine
> Vasopressin (ADH)

Medical Management of a Patient With Cardiogenic

Shock
Treatment requires aggressive approach where its goals are to

treat the underlying cause, enhance the effectiveness of the

pumping function, and improve tissue perfusion.
Inotropic agents increase myocardial contractility and maintain
adequate blood pressure and improve tissue perfusion.
Inotropic agents include cardiac glycosides (digoxin),
sympathomimetic agents (epinephrine, dopamine,
norepinephrine, dobutamine), and phosphodiesterase inhibitors
(amrinone, milrinone).
Diuretics (lasix) to decrease preload (volume of blood in the
left ventricle at the end of diastole).
Vasodilators are used after stabilising blood pressure to reduce
preload and afterload which is the ventricular wall tension
during systolic ejection. Afterload means an increase in the
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work of heart.

Medical Management of a Patient With Cardiogenic

Shock (Continued)
Antidysrhythmic agents (lidocaine, propranolol) to suppress

dysrhythmias (disturbance in the normal cardiac conduction

pathway). Regular and irregular heart rate calculations are
presented on next two slides.
Intubation and mechanical ventilation may be indicated to
support oxygenation.
If drug therapy is unsuccessful, intraaortic balloon pump
(IABP) support should be instituted. IABP is a temporary
measure to decrease myocardial workload by improving
myocardial supply and decreasing myocardial demand. IABP
inflates during diastole and deflates just before systole.

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Nursing Management : Our main

Focus

NURSING MANAGEMENT
Monitoring Hemodynamic Status:
Assess vitals regularly.
Maintain a patent arterial line, if any
Assess functioning of ECG monitor &
readings

Administering medications & IV

fluids:
Monitor vitals before and after administering
medications & IV fluids.
Administer prescribed medications & fluids
accurately (Follow10 Rights)
Assess IV infusion site for bleeding or any
allergic response.
Monitor:
- Urine Output
- BUN
Indicators of renal
function

- Serum Creatinine

Preventing Complications:
Notify the physician promptly if:
- Hemodynamic, Cardiac or Pulmonary status
changes.
- Decline in ABG or Pulse Oximeter values
- Adventitious breath sounds heard
- Changes in cardiac rhythm

Nursing management of Patient With Cardiogenic Shock

Limit myocardial oxygen demand by:
Administering analgesics, sedatives, and other agents as

prescribed.
Positioning the patient for comfort.
Limiting activities.
Providing calm and quiet environment
Offering support to reduce anxiety.
Teaching the patient about his condition.
Enhancing myocardial oxygen supply by:
Administering oxygen.
Monitoring the patients respiratory status.
Administering prescribed medications.
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Nursing management of Patient With Cardiogenic Shock

(Continued)
Providing comfort and psychological support.
Moving the patient Q2H to prevent pressure ulcers.
Observing for IABP-related complications such as:
Embolus formation: Assess peripheral pulses.
Infection.
Thrombocytopenia.
Bleeding.
Balloon rupture due to repeated contact with calcified plaque in

the aorta as the balloon inflates and deflates.

Circulatory compromise of the cannulated extremity.

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NURSING DIAGNOSIS
Ineffective cardiopulmonary tissue perfusion r/t acute myocardial

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ischemia
Decreased cardiac output r/t alterations in contractility
Decreased cardiac output r/t alterations in heart rate
Imbalanced nutrition : less than body requirements r/t increased
metabolic demands or lack of exogenous nutrients
Risk for infection
Disturbed body image r/t functional dependence on life sustaining
technology