Cardiogenic shock produces symptoms of poor tissue perfusion.
- Clammy skin. The patient experiences cool, clammy skin as the blood could not circulate properly to the peripheries.
- Decreased systolic blood pressure. The systolic blood pressure decreases to 30 mmHg below baseline.
- Tachycardia. Tachycardia occurs because the heart pumps faster than normal to compensate for the decreased output all over the body.
- Rapid respirations. The patient experiences rapid, shallow respirations because there is not enough oxygen circulating in the body.
- Oliguria. An output of less than 20ml/hour is indicative of oliguria.
- Mental confusion. Insufficient oxygenated blood in the brain could gradually cause mental confusion and obtundation.
- Cyanosis. Cyanosis occurs because there is insufficient oxygenated blood that is being distributed to all body systems.
Assessment and Diagnostic Findings
Diagnosis of cardiogenic shock may include the following diagnostic tests:
- Auscultation. Auscultation may detect gallop rhythm, faint heart sounds and, possibly, if the shock results from rupture of the ventricular septum or papillary muscles, a holosystolic murmur.
- Pulmonary artery pressure (PAP). PAP monitoring may show increase in PAP, reflecting a rise in left ventricular end-diastolic pressure and increased resistance to the afterload.
- Arterial pressure monitoring. Invasive arterial pressure monitoring may indicate hypotension due to impaired ventricular ejection.
- ABG analysis. Arterial blood gas analysis may show metabolic acidosis and hypoxia.
- Electrocardiography. Electrocardiography may show possible evidence of acute MI, ischemia, or ventricular aneurysm.
- Echocardiography. Echocardiography can determine left ventricular function and reveal valvular abnormalities.
- Enzyme levels. Enzyme levels such as lactic dehydrogenase, creatine kinase. Aspartate aminotransferase and alanine aminotransferase may confirm MI.
The aim of treatment is to enhance cardiovascular status by:
- Oxygen. Oxygen is prescribed to minimize damage to muscles and organs.
- Angioplasty and stenting. A catheter is inserted into the blocked artery to open it up.
- Balloon pump. A balloon pump is inserted into the aorta to help blood flow and reduce workload of the heart.
- Pain control. In a patient that experiences chest pain, IV morphine is administered for pain relief.
- Hemodynamic monitoring. An arterial line is inserted to enable accurate and continuous monitoring of BP and provides a port from which to obtain frequent arterial blood samples.
- Fluid therapy. Administration of fluids must be monitored closely to detect signs of fluid overload.
Drug used may include:
- IV dopamine. Dopamine, a vasopressor, increases cardiac output, blood pressure, and renal blood flow.
- IV dobutamine. Dobutamine is an inotropic agent that increase myocardial contractility.
- Norepinephrine. Norepinephrine is a more potent vasoconstrictor that is taken when necessary.
- IV nitroprusside. Nitroprusside is a vasodilator that may be used with a vasopressor to further improve cardiac output by decreasing peripheral vascular resistance and reducing preload.