2808NRS Human Pathophysiology Cardiogenic Shock Case Study

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Case Study
AI Summary
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.
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Human
Pathophysiology and
Pharmacology
A Case Study
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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.
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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
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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.
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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.
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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
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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
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General factors
Acute myocardial infarction
Failure of pump
Severe ischemia
Expansion of infarction
Mechanical complications
Rupture of free wall
Pericardial tamponade
Right ventricular infarction
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Other
conditions
Mitral stenosis
Aortic stenosis
Mitral regurgitation
Myocardial contusion
Myocarditis
End stage cardiomyopathy
Left ventricular filling obstruction
Obstructive cardiomyopathy
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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
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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
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Causes
Possible chances for causing cardiogenic shock
include
Acute myocardial infarction
Rupture of papillary muscle
Free wall rupture
Systolic failure
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Pathophysiology
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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
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Treatment
Treatment include
Support on temporary basis –
Vasopressor ,Mechanical support
Specific measures –
Cardiac transplantation,
Revascularization,
Fibrinolysis.
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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.
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Pharmacologi
cal treatment
Drugs include –
Dopamine,
Norepinephrine,
Dobutamine,
Amrinone and milrinone can be use for
improvement of cardiac related output
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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
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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.
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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.
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