Draft

41  Cardiogenic Shock

41.1 What this covers

  • Preschock normotensive Hypoperfusion
  • Preshock hypotensive normoperfusion
  • LV-dominant

41.2 Learning objectives

  • Preschock normotensive Hypoperfusion
  • Preshock hypotensive normoperfusion
  • LV-dominant
  • RV-dominant
  • Bi-V CS
  • E: extremis
  • D: deteriorating/Doom - c, but not responding

41.3 Bottom line / summary

  • Categorizing shock: !alt
  • Based on invasive hemodynamic parameters.
  • Note: ESCAPE trial - decompensated HF - RCT with no benefit to RHC/Swan, however not in shock patients.
  • Some subsequent retrospective data that does suggest a benefit.
  • Cardiac Power Output: MAP & CO / 451.

41.4 Approach

  1. Preschock normotensive Hypoperfusion
  2. Preshock hypotensive normoperfusion
  3. LV-dominant
  4. RV-dominant
  5. Bi-V CS

41.5 Red flags / when to escalate

  • Preshock hypotensive normoperfusion
  • C: Classic cardiogenic shock - hypotension
  • B: beginning cardiogenic shock - relative hypotension or compensatory tachycardia without hypo perfusion.
  • A: pre-shock/ at risk
  • Categorizing shock: !alt

41.6 Common pitfalls

  • TODO: Capture common errors or missed steps.

41.7 References

  • https://photos.collectednotes.com/photos/5187/2ba49f2a-c6e1-4f30-9853-1737a0560615
  • https://photos.collectednotes.com/photos/5187/c241b54b-59a9-451e-9bd2-aaf2827cfa7e

41.8 Source notes

41.8.1 Cardiogenic Shock

42 Cardiogenic shock

Categorizing shock: alt

  • Preschock normotensive Hypoperfusion
  • Preshock hypotensive normoperfusion
  • LV-dominant
  • RV-dominant
  • Bi-V CS

Based on invasive hemodynamic parameters. Note: ESCAPE trial - decompensated HF - RCT with no benefit to RHC/Swan, however not in shock patients. Some subsequent retrospective data that does suggest a benefit.

Cardiac Power Output: MAP & CO / 451. The strongest correlate of mortality; 0.53W is the threshold, can be used to track response.

Pulmonary Artery Pulsatility Index: [PAS - PAD] / [CVP or RAP]. If PA Capacitance and CPWP is constant, it’s a proxy for the Frank-Starling relationship. Studied mostly who will need RV support when getting LVAD

Shock Stages:

  • E: extremis
  • D: deteriorating/Doom - c, but not responding
  • C: Classic cardiogenic shock - hypotension
  • B: beginning cardiogenic shock - relative hypotension or compensatory tachycardia without hypo perfusion.
  • A: pre-shock/ at risk

Shock team approach? Maybe earlier/more MCS in pre-post

alt

42.1 Source materials