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Cardiogenic shock

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Definition

Shock due to the heart not pumping properly

Epidemiology

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Pathophysiology

Something stops your heart pumping; this is bad. Here's a list of somethings:

Risk Factors

Clinical Features

Depends on the cause.

Investigations

Keep your eye on central venous pressure, BP, ABG, ECG.

Management

Generally, by this point they'll have all sorts of clever stuff like a central line in. This allows you to measure stuff and it you can measure Pulmonary Capillary Wedge Pressure (PCWP). (They ram a pressure-measuring device as far into the lung as possible. It's wedge shaped. It gets stuck. You measure the pressure.) If PCWP <15mmHg

  • Give plasma expander (typically colloid) 100ml/15min iv. Aim for PCWP 15-20mmHg.

If PCWP >15mmHg

  • Dobutamine (inotropic support) 2.5-10 micrograms/kg/min. Aim systolic BP >80mmHg.

If both these fail, consider:

  • Dopamine 2.5microgrames/kg/min via central line
  • Intra-aortic balloon pump

Treat the cause when you can.

Prognosis