Cardiogenic Shock.pptx

For 2nd year B.Sc Nursing students

1. CARDIOGENIC SHOCK Presented By: Mr. Nandish.S Asso. Professor Mandya Institute of Nursing Sciences

2. DEFINITION OF SHOCK: It is a syndrome characterized by decreased tissue perfusion and impaired cellular metabolism. It is a failure of circulatory system to maintain adequate perfusion to vital organs. It is a state of cellular & tissue hypoxia due to either reduced oxygen delivery, increased oxygen consumption, inadequate oxygen utilization or a combination of these processes to vital organs. It is a life threatening condition that occurs when the body is not getting enough blood supply.

3. TYPES OF SHOCK : Cardiogenic Shock Hypovolemic shock Neurogenic Shock Septic Shock Anaphylactic shock

4. CARDIOGENIC SHOCK : It occurs when either systolic or diastolic dysfunction of the myocardium results in compromised cardiac output. It is also called as cardiac shock, happens when heart cannot pump enough blood to meet body’s needs. it occurs when the heart is unable to function adequately resulting in insufficient blood flow to tissues and organs.

5. ETIOLOGY & RISK FACTORS : Systolic Dysfunction : it occurs due to inability of the heart to pump blood forward. Myocardial Infarction Cardiomyopathy Diastolic Dysfunction : it occurs due to inability of the heart to fill during diastole. Cardiac tamponade Arrhythmias Tachycardia Bradycardia Continued ………

6. Structural Factors / Problems Valvular abnormality (stenosis, regurgitation) Papillary muscle dysfunction Acute ventricular septal defect. Other factors Endocarditis Myocarditis Sepsis Peripheral vascular disease Cerebro vascular disease Pneumothorax Acute aortic insufficiency

7. PATHOPHYSIOLOGY : Structural problems Systolic dysfunction : ineffective forward movement of blood Decreased stroke volume Decreased cardiac output Decreased cellular oxygen supply Decreased Tissue perfusion Impaired cellular metabolism

8. Arrhythmias Diastolic dysfunction : ineffective filling Increased pulmonary pressure Pulmonary Oedema Decreased Oxygenation Decreased tissue perfusion Impaired cellular metabolism

9. CLINICAL MANIFESTATIONS : Tachycardia Hypotension Narrowed pulse pressure Pulmonary congestion (presence of crackles) Increased Pulmonary A rtery W edge P ressure (PAWP) Cyanosis Pallor Cool & clammy skin Capillary refill time more than 3 seconds Oliguria Continued …………..

10. Anxiety Delirium / confusion Chest pain Nausea & vomiting Palpitation Syncope Restlessness Dyspnoea

11. DIAGNOSTIC STUDIES : History collection & Physical Examination Blood examination Complete blood count ABG Analysis Cardiac Enzymes ECG Chest X - Ray Echocardiogram Angiogram

12. MANAGEMENT : The goal of management is : - To restore the blood flow to myocardium by restoring the balance between oxygen supply and demand.

13. MAINTAINING OXYGEN SATURATION / LEVEL Improve oxygen delivery by decreasing demand. Provide analgesics & anxiolytics to relax muscles. Maintain arterial Oxygen saturation by providing supplemental oxygen. Maintain Hemoglobin level more than 10g/dl. Monitor central venous oxygen saturation to rule out tissue oxygen extraction.

14. OPTIMIZING CIRCULATION : Initiate isotonic crystalloid fluids. Maintain central venous pressure (CVP) between 8 – 12 mm of Hg. Patients may require 4 to 6 litres of fluid per day. Measure the urine output and report if output is less than 30 ml / hour. Improve heart rate and it should not fall below 60. Place the patient in supine position with leg end elevation (45 degree).

15. PHARMACOLOGIC THERAPY : Dilate coronary arteries – Nitrates Improve contractility – inotropes (Epinephrine) Reduce preload – ACE Inhibitors, Diuretics, Morphine Reduce afterload – phospho-diesterase inhibitors, vasodilators Reduce heart rate – β Adrenergic blockers, calcium channel blockers ( Amlong ) Reduce contractility - β Adrenergic blockers ( Aten )

16. OTHER TREATMENT: Intra Aortic Balloon Pump (IABP) Ventricular Assist Device (VAD) Angioplasty & Stent Coronary Artery Bypass Graft (CABG) Percutaneous Transluminal Coronary Angioplasty (PTCA) Thrombolysis Cardiac Transplantation.

17. NURSING DIAGNOSIS : Decreased cardiac output related to impaired cardiac contractility as manifested by hypotension. Impaired gas exchange related to pulmonary congestion as manifested by decreased oxygen saturation levels. Impaired tissue perfusion related to decreased cardiac contractility & blood flow as manifested by increased capillary refill time. Fear & Anxiety related to intensive care environment as evidenced by fearful facial expression. Activity intolerance related to decreased cardiac activity & laboured respirations as evidenced by difficulty in performing ADL.

18. THANK YOU