Cardiogenic Shock Lecture

Anatomy of the Heart

Compartments: Right atrium, right ventricle, left atrium, left ventricle.
Function: Right heart pumps blood to the lungs; left heart pumps oxygenated blood to the body.

Cardiac Output: Essential for delivering oxygen and nutrients.
Failure Causes:
- Valvular Problems: Damaged/narrowed aortic outflow tract
- Arrhythmias: Disrupted electric conduction
- Ventricular Wall Stiffness: Limits contractility
Heart Attacks (MIs): Major cause of cardiogenic shock

Pulmonary Congestion: Blood backs up into the lungs, causing difficulty in breathing and a productive cough.
Jugular Venous Distention (JVD): Blood backs up into the venous system, distending the jugular vein.
Angina: Chest pain due to oxygen deprivation.
Organ Dysfunction: Decreased urine output, organ failure due to inadequate oxygenation.
Cool Skin: Blood diverted away from the skin to vital organs.

Typical Labs:
- Serum Lactate & ABG: Assess oxygenation and tissue utilization.
- Troponins: Check for myocardial damage (e.g., heart attack).
- Chest X-ray: Identify pulmonary congestion.
- EKG: Identify arrhythmias or heart attacks.
- Echocardiogram: Assess heart contractility.
Important Measures:
- PCWP: Elevated >18mm Hg (backup pressure in pulmonary arteries).
- Cardiac Index: <2.2 L/min/m² (standardized cardiac output).

Oxygen Support: Provide to ensure tissue oxygenation.
Cardiovascular Support:
- Increase Systemic Vascular Resistance: Use vasopressors (e.g., norepinephrine, epinephrine).
- Improve Heart Contractility: Medications to enhance contraction.
Correct Underlying Issues:
- Revascularization: Restore blood flow in occluded vessels.
- Valve Repair/Replacement: Fix or replace faulty valves.
- Heart Transplant: In severe cases, replace the heart.

Cardiogenic shock is a condition where the heart fails to pump sufficient blood, leading to poor oxygen delivery to the body's tissues and organs.