2808NRS Human Pathophysiology Cardiogenic Shock Case Study

This case study focuses on cardiogenic shock, a critical condition stemming from acute myocardial infarction leading to impaired cardiac output. The assignment analyzes the aetiology and pathophysiology, including myocardial dysfunction, dysrhythmias, and structural abnormalities that result in decreased tissue perfusion and reduced oxygen supply. It details the clinical presentation, including chest pain, tachycardia, and cool extremities, alongside diagnostic indicators. The study explores treatment options like vasopressors, mechanical support, and revascularization, complemented by pharmacological interventions. A concept map illustrates the connections between risk factors, aetiology, pathophysiology, clinical presentation, and treatment, supported by references to relevant medical literature. The study emphasizes the importance of understanding cardiogenic shock for effective healthcare management.

Human
Pathophysiology and
Pharmacology
A Case Study

Cardiogeni
c Shock
CARDIOGENIC SHOCK IS
OBSERVED WHEN HEARTS
GETS DAMAGED DUE TO
LACK OF BLOOD SUPPLY TO
THE ORGANS PRESENT IN
THE BODY,
DEFICIENCY IN NUTRIENT
SUPPLY LEADS TO FALL OF
BLOOD PRESSURE AND
ORGAN FAILURE. CARDIOGENIC SHOCK IS
VERY UNCOMMON AND
SHOULD BE TREATED AFTER
QUICK RECOGNITION.

Signs and
Symptoms(Cardioge
nic Shock)
Anxiety Confusion
Profuse sweating
Very low urine output
or completely absent
- Oliguria
Fatigue Shortness of breath
Heart beat is weak
but rapid –
Tachycardia
Chances of patient
experiencing Coma
condition

Case
Study
Scenario
Medical history of Erik Selvig indicates suffering
from psoriasis, hypertension, hypertrophic
cardiomyopathy and dysponea condition
Initially several tests and ECG is performed and
it shows Erik has anterior ST-myocardial
infarction with normal blood pressure range.
After three hours there was sudden decrease in
blood pressure, Worsening dysponea condition,
Skin became pale, cool and mottled.
The outcome of diagnosis indicates cardiogenic
shock because of dysfunction of ventricular
pump.

Diagnosis
ECG was performed and it
revealed anterior ST-
myocardial infarction
Blood pressure initially
found to be normal.
Dyspnoea is identified.
Once dyspnoea got
worsened there is drop in
blood pressure
Erik got diagnosed with
cardiogenic shock due to
dysfunction of ventricular
pump.

Risk
factors
Some of the risk factors associated with Erik’s
condition include
Earlier reports suggest that Erik had myocardial
infarction(heart attack).
Build up of plaque in the coronary arteries.
Old age and
High blood pressure

Aetiology
Cardiogenic shock is mainly due to heart
attack resulted due to restriction of blood
flow through arteries.
Some of the conditions that cause
Cardiogenic shock include-
• Ventricular tachycardia
• Ventricular fibrillation
• Heart muscle unable to work properly
• Pulmonary embolism – Artery blockage
• Build up of fluid – Pericardial Tamponade
• Overdosage of drugs affects heart to pump blood
leading to Cardiogenic Shock

General factors
• Acute myocardial infarction
Failure of pump
Severe ischemia
Expansion of infarction
• Mechanical complications
Rupture of free wall
Pericardial tamponade
Right ventricular infarction

Other
conditions
Mitral stenosis
Aortic stenosis
Mitral regurgitation
Myocardial contusion
Myocarditis
End stage cardiomyopathy
Left ventricular filling obstruction
Obstructive cardiomyopathy

Examination
• General exam:
 Hypertrophic cardiopathy
 Dysponea
 Cool extremities
• Vitals:
 Anterior ST-myocardial infarction
 Blood pressure- 124/73 mg.
 3 hours later,
 Blood pressure – 76/30 mg
 Skin became cool, pale and mottled
 Confused personality
 Ventricular pump dysfunction

Pathophysiol
ogy
• Due to Acute myocardial infarction it
results in
Myocardial dysfunction, dysrhythmias
or structural abnormalities
Impaired cellular metabolism
Decreased tissue perfusion
Decrease in supply of oxygen supply
Decrease in cardiac output
Decreased stroke volume

Causes
Possible chances for causing cardiogenic shock
include
Acute myocardial infarction
Rupture of papillary muscle
Free wall rupture
Systolic failure

Pathophysiology

Clinical
presentatio
n
• There is evidence of myocardial infarction which
indicates there is
Abrupt onset of squeezing,
pain in chest
Pain could be sharp or burning
Sinus tachycardiac condition
Very less urine output
Cool extremities

Treatment
• Treatment include
• Support on temporary basis –
Vasopressor ,Mechanical support
• Specific measures –
Cardiac transplantation,
Revascularization,
Fibrinolysis.

Manageme
nt
In order to avoid damage of organ
due to hyper fusion correction of
haemodynamic is considered as
essential.
Liver shock and other organ
damage could be avoided.
It is important to control hypoxia,
arrhythmias and hyperglycaemia.

Pharmacologi
cal treatment
Drugs include –
Dopamine,
Norepinephrine,
Dobutamine,
Amrinone and milrinone can be use for
improvement of cardiac related output

Concept map-
Cardiogenic shock
• Cardiogenic shock is due to impaired myocardial
infarction that results in diminishing cardiac output.
• Key areas covered under concept map –
• Pathophysiology
• Diagnosis
• Risk factors
• Clinical presentation
• Treatment

Summary
and
Conclusion
Cardiogenic Shock generally exhibits high
morbidity and mortality which leads to death of
an individual and specifically observed in
patients suffering from acute myocardial
infarction.
Early treatment procedures include
revascularization,devices that provide
mechanical support and application of
vassopressors or inotropes to achieve stability
is encouraged along with pharmacotherapy.
Since there are many aetiologies associated
with heart failure, should be treated using
vasopressors/inotropes or mechanical support
procedures.

References:
• Buerke, M.H., Lemm, S., Dietz, & Werdan,k. (2011). Pathophysiology, diagnosis, and treatment of
infarction related cardiogenic shock. ‐ Herz, 36,73– 83.
• Rostoff, P. (2018).Fulminant adrenergic myocarditis complicated by pulmonary edema, cardiogenic
shock and cardiac arrest. Am J Emerg Med,36(2):344.e1-344.e4.
• Reynolds, H.R. & Hochman,J.S.(2008).Cardiogenic shock. Current concepts and improving
outcomes,Circulation,117:686–697.
• Harjola,V-P.,Lassus,J. & Sionis,A.(2015).Clinical picture and risk prediction of short-term mortality in
cardiogenic shock.Eur J Heart Fail,17,501-9.
• Mebazaa, A.H.,Tolppanen, C. & Mueller (2016). Acute heart failure and cardiogenic shock: a
multidisciplinary practical guidance. Intensive Care Med. 42, 147– 163.
• Tarvasmaki, T. J., Lassus, M. & Varpula (2016). Current real life use of vasopressors and inotropes in‐
cardiogenic shock adrenaline use is associated with excess organ injury and mortality. ‐ Crit.
Care 20,208.