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The patient with acute cardiovascular problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Cardiogenic shock is a complex condition to manage and requires a wide range of monitoring techniques to guide its management. Inotropic drugs to increase ventricular contractility are essential to restore cardiac output in the short-term, but careful titration of these drugs is needed, as they can be harmful. These measurements and treatments require invasive haemodynamic monitoring systems that would normally only be found in an intensive care (level 3) setting for stabilisation, but further assessment may indicate that transfer to a cardiac specialist centre is required.
The cardiovascular system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Mary N Sheppard, C. Simon Herrington
Cardiogenic shock is caused by severe acute reduction in cardiac output because of pump failure; most often this is due to cardiac catastrophes such as massive myocardial infarction, rupture of a valve cusp, or cardiac tamponade due to haemopericardium. The main metabolic and circulating effects are summarized in Figure 7.4. Unlike other forms of shock, both the central venous pressure and the ventricular end-diastolic pressures are raised. The haemodynamic changes are otherwise similar to hypovolaemic shock; they are triggered by the fall in blood pressure and the reduced tissue perfusion. The mortality rate approaches 80%. Surgical intervention is sometimes appropriate and aortic pumps can support the circulation before surgery.
The circulatory system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
Possible causes of cardiogenic shock include: Heart failureMyocardial infarctionCardiomyopathyCardiac tamponadePneumothoraxCardiac arrhythmia
Outcomes of surgical Impella placement in acute cardiogenic shock
Published in Baylor University Medical Center Proceedings, 2023
Timothy J. George, Jenelle Sheasby, J. Michael DiMaio, Nitin Kabra, David A. Rawitscher, Aasim Afzal
Patient demographics, comorbidities, laboratory values, measures of acuity, operative data, and outcomes were extracted from the electronic medical record. Patients were broadly classified into three etiologies for cardiogenic shock. The first etiology was AMI complicated by shock. These patients had clinical, angiographic, and laboratory-confirmed evidence of myocardial injury in the setting of compromised end-organ perfusion. The second was acute on chronic heart failure. These patients had a history of heart failure with reduced ejection fraction who presented with a combination of heart failure exacerbation and compromised end-organ perfusion. The third was postcardiotomy shock. This group comprised patients with compromised end-organ perfusion within 48 hours of cardiac surgery. There was one patient who had refractory ventricular tachycardia who was not easily grouped into any of the three categories.
COVID-19 and cardiovascular disease: manifestations, pathophysiology, vaccination, and long-term implication
Published in Current Medical Research and Opinion, 2022
Adel Abdel Moneim, Marwa A. Radwan, Ahmed I. Yousef
Heart failure in COVID-19 is mediated by various mechanisms such as virus-induced infiltration of inflammatory cells that could deteriorate cardiac function. Pro-inflammatory cytokines (i.e. tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and IL-6) can cause endothelial injury. When coupled with micro-thrombosis, these can also damage the endocardium and cause necrosis and death of the myocardium. Furthermore, ARDS and respiratory failure can induce heart failure as a result of severe hypoxia (Figure 1)59. Of 901 admissions to an ICU due to COVID-19, 80 (8.9%) had acute heart failure, including 18 (2.0%) with classic cardiogenic shock and 37 (4.1%) with vasodilatory cardiogenic shock32. Cardiogenic shock can be either mainly cardiac in the cause or have a mixed pulmonary and cardiac pathogenesis60 (Figure 1, Table 1).
Echocardiography in a critical care unit: a contemporary review
Published in Expert Review of Cardiovascular Therapy, 2022
Muhammad Mohsin, Muhammad Umar Farooq, Waheed Akhtar, Waqar Mustafa, Tanzeel Ur Rehman, Jahanzeb Malik, Taimoor Zahid
Pathophysiology of cardiogenic shock is caused by depressed myocardial function causing decreased cardiac output, circulatory collapse, end-organ hypoperfusion, and hypoxia. It is defined as systolic blood pressure of <90 mmHg for ≥ 30 minutes or use of mechanical and/or pharmacological support to maintain a systolic blood pressure of ≥ 90 mmHg, in addition to the clinical evidence of end-organ hypoperfusion because of LV or RV dysfunction. The majority of the patients admitted with cardiogenic shock in CCUs have an AMI. LV systolic dysfunction is invariably present with cardiogenic shock, which is easily demonstrated during echocardiography. A qualitative assessment of the LV can be made on a visual 2D assessment of the cardiac chambers in PLAX or PSAX view. Expert readers of echocardiography can accurately diagnose LV function by ‘eyeballing’ fairly accurately. For other readers, a quantitative assessment of LV function can be performed for true estimation of LV function by a modified Simpson’s biplane method.