Symptoms of hypertrophic cardiomyopathy - ANSWER-Similar to
*diastolic heart failure*- treatment same
Fatigue
Dyspnea
Chest pain
Palpitations
S3, S4
Presyncope or syncope
Cardiogenic shock - ANSWER-A state in which not enough
oxygen is delivered to the tissues of the body, caused by low
output of blood from the heart.
-When compensatory mechanisms fail to maintain cardiac output
Extreme drop in stroke volume secondary to systolic dysfunction,
results in:
,2|Page
--Elevated left ventricular preload (PAOP) with associated
pulmonary symptoms
--Elevated left ventricular afterload (SVR) due to vasoconstrictive
compensatory mechanisms
--Results in a drop in cardiac output to the point where perfusion
to organs is no longer adequate
Causes of cardiogenic shock - ANSWER-Most common- extreme
drop in stroke volume secondary to systolic dysfunction
Acute MI
Chronic heart failure
Cardiomyopathy
Dysrhythmias
Cardiac tamponade
Papillary muscle rupture
Clinical presentation of cardiogenic shock: Compensatory stage -
ANSWER-Tachycardia
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Tachypnea
Crackles, mild hypoxemia
ABG with respiratory alkalosis or early metabolic acidosis
Anxiety, irritability
Neck vein distention
S3 (S4 if also an acute MI)
Cool skin
Decreased urine output
*Narrow pulse pressure*
B/P maintained, but lower than baseline
Clinical presentation of cardiogenic shock: Progressive stage -
ANSWER-Hypotension
Worsening tachycardia, tachypnea, oliguria
Metabolic acidosis
Worsening crackles and hypoxemia
Skin clammy, mottled
Worsening anxiety or lethargy
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---*at any time, chest pain or arrhythmias may occur*
Treatment of cardiogenic shock - ANSWER-Identify cause
Manage arrhythmias (brady, tachy) that may be contributing to a
decrease in CO
Reperfusion if STEMI (PCI or fibrinolytic therapy)
Emergent surgery if due to mechanical problem (ruptured
papillary muscle, VSD)
Treatment of cardiogenic shock: Enhance effectiveness of pump -
ANSWER-*Positive inotropes*
--Levo
--Dopamine 4-10 mcg/kg/min
--Dobutamine, milrinone
*AVOID negative inotropes*! (Vasodilators)
--May be used in conjunction with intra-aortic balloon pump
therapy and positive inotropes *IF* in progressive stage with
hypotension
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