Cardiogenic Shock Case Study: Nursing, Patient Erik Selvig Analysis

This case study examines the medical condition of Erik Selvig, who presented to the emergency department with worsening dyspnea and cool, clammy extremities, and a history of hypertension, psoriasis, and hypertrophic cardiomyopathy. Initial diagnosis revealed hypotension, an anterior ST myocardial infarction, and subsequent deterioration with bilateral crackles and confusion, leading to a diagnosis of cardiogenic shock due to ventricular pump dysfunction. The study explores the risk factors, including gender and pre-existing conditions like psoriasis and myocardial infarction, and delves into the pathophysiology, highlighting ischemia, hypotension, and the impact on organ perfusion. Diagnostic investigations, such as ECG and echocardiogram, are discussed, along with treatment options including inotropic agents, vasodilators, and beta-blockers. The case study underscores the complexity of cardiogenic shock and the importance of prompt diagnosis and management.

Running head: NURSING
NURSING
Name of the Student
Name of the University
Author Note

1NURSING
Concept Map (Hypertrophic cardiomyopathy)
Keywords :
 Risk factors
 Pathophysiology
 Diagnostics
 Clinical manifestation
 Treatment
 Aetiology
Ventricular pump Dysfunction,
Thickening of coronery arteriole
Myocardial infarction
ECG, Echocardiogram
Dyspnoea, cool &
clammy extremities,
Pale
Vasodilators,
Restricted blood supply to the
myocardium
Ischemia
Cardiogenic shockHypotension
(76/30) Confused to person,
place and time
ACE inhibitors Inotrophic agent
Beta–blockers, calcium
channel blockers
vital signs measurement (BP, pulse,
Respiratory rate, heart rate, blood
test
Bilateral crackles
Psorasis
Hypertrophic
cardiomyopathy
Hypertension
Ineffective pumping of blood
Gender: male

2NURSING
Risk factors, Aetiology
The following case study deals with the medical condition of a patient named Erik
Selvig. He had a medical history of hypertension, psoriasis and hypertrophic cardiomyopathy.
He was presented to the emergency department due to worsening dyspnoea as well as cool
clammy extremities. On diagnosis, Blood pressure was recorded to be 124/73 mm/Hg and his
ECG reveals to have experienced anterior ST myocardial infarction. The case study further
adds that after three hours of his arrival in the emergency, his dyspnoea deteriorated along
with crackles bilaterally. His blood pressure also dropped to 70/30mm/Hg, his skin became
pale and cool and suffered from confusion. The physicians diagnosed that Erik had diagnosed
with cardiogenic shock because of ventricular pump dysfunction. Gender can be another risk
factor for ventricular dysfunction in patient. Women has been found to be having a better
cardiac function than men.
Cardiogenic shock is defined as a diseased condition where one individual’s heart
suddenly stops pumping blood (Lim, 2016). Cardiac pump failure is often caused due to
massive heart attack but not in case of all individuals. 80% of individuals having a heart
attack may not lead to a cardiogenic shock. The main risk factors behind the cause of the
ventricular pump dysfunction can be due to damaged heart muscles, caused due to
myocardial contusion. The case study states that there had been a past history of myocardial
infarction in Erick Selving. Another risk factor associated to Erick is psoriasis. Studies have
found that the inflammation associated with psoriasis can increase the risk of the stroke and
heart attack as the inflammation tends to damage the arteries, causing blockage or plaques
inside the blood vessels (Van Herck et al., 2017). Psoriasis has again been associated hyper
cardiomyopathy as recently the inflammation characteristics of cardiomyopathies have been
discovered.

3NURSING
Pathophysiology and clinical manifestations
The pathophysiology of cardiogenic shock is quite complex. Ischemia in the
myocardium causes derangement to both the systolic and diastolic left ventricular function,
causing a depression in the myocardial contractility.
The main cause of cardiogenic shock is insufficient blood supply to body tissues as
well as organs. Hypotension is mainly caused due to the inadequate organ perfusion, caused
due to low cardiac output or low systemic vascular resistance. Therefore, blood pressure falls
in cardiogenic shock as it tries to compensate by limiting the flow of blood to the extremities
(Smith& Bigham, 2013). Due to fall in blood pressure, the hands and feet also cool down, as
manifested by Erick Selvig. Erick with cardiogenic shock suffers from dyspnoea, due to low
cardiac output, which is unable to meet the oxygen demands of the body leading to ischemia
due to inadequate tissue perfusion. This can further lead to the blood to back up to
accumulate in blood vessels from lungs to the heart. In case the fluid leaks and gathers in the
lungs (Lim, 2016). Worsening dyspnoea in Erick indicates more severe heart conditions.
With worsening conditions, Erick Selvig had also displayed bilateral crackles. According to
Smith and Bigham, (2013) bilateral crackles have been associated with formation of
pulmonary oedema, in patients with congestive heart failure.
It had already been stated that in cardiomyopathies, the pumping ability of the heart
decreases causing a failure if the ventricular pump and ultimately leading to the cardiogenic
shock (Prabhavathi et al., 2016). There is obstruction in pumping of blood from the left
ventricle which results in insufficient blood supply to the tissues leading to cardiogenic shock
in Eric. Such condition is also referred as ventricular pump dysfunction (Smith & Bigham,
2013).

4NURSING
Diagnostic investigations and treatment
Cardiogenic shock is normally demonstrated in an emergency setting. Diagnostic
evaluation of cardiogenic shock involves a complete blood test, a comprehensive metabolic
panel, phosphorus, magnesium, arterial blood gas test, Chest X-ray, Electrocardiogram,
coronary angiography (Smith & Bigham, 2013). ECG is suitable for Erik Selving, as it will
help in detecting the electrical conductivity of the heart by electrodes attached to the heart.
Agan an echocardiogram will be helpful to measure the ejection fraction.
Treatment
Dopamine should be incorporated to patients in order to raise the blood pressure level.
Common treatment for cardiogenic shock includes administration of sympathomimetic
amines with alpha and beta adrenergic effects. Several medications are available in order to
treat hypertrophic cardiomyopathy. Drugs like beta blockers- propranolol, esmolol and many
more; and calcium channel blockers- nifedipine, diltiazam. This will help in decreasing the
high blood pressure in the patient, by relaxing the arterial wall of Erik Selving (Van Herck et
al., 2015).

5NURSING
References
Christ M & Mueller C (2015) Call to action: initiation of multidisciplinary care for acute
heart failure begins in the emergency department. Eur Heart J Acute Cardiovasc Care
doi: 10.1177/2048872615581501
Citro, R., Rigo, F., D'Andrea, A., Ciampi, Q., Parodi, G., Provenza, G., ... & Patella, M. M.
(2014). Echocardiographic correlates of acute heart failure, cardiogenic shock, and in-
hospital mortality in tako-tsubo cardiomyopathy. JACC: Cardiovascular Imaging,
7(2), 119-129.DOI: 10.1016/j.jcmg.2013.09.020
Harjola, V. P., Lassus, J., Sionis, A., Køber, L., Tarvasmäki, T., Spinar, J., ... & Di Somma,
S. (2015). Clinical picture and risk prediction of short‐term mortality in cardiogenic
shock. European journal of heart failure, 17(5), 501-
509.https://doi.org/10.1002/ejhf.260
Lim, H. S. (2016). Cardiogenic shock: failure of oxygen delivery and oxygen
utilization. Clinical cardiology, 39(8), 477-483. https://doi.org/10.1002/clc.22564
Prabhavathi, K., Selvi, K. T., Poornima, K. N., & Sarvanan, A. (2014). Role of biological sex
in normal cardiac function and in its disease outcome - a review. Journal of clinical
and diagnostic research : JCDR, 8(8), BE01–BE4.
doi:10.7860/JCDR/2014/9635.4771
Pöss, J., Köster, J., Fuernau, G., Eitel, I., de Waha, S., Ouarrak, T., ... & Desch, S. (2017).
Risk stratification for patients in cardiogenic shock after acute myocardial
infarction. Journal of the American College of Cardiology, 69(15), 1913-
1920.DOI: 10.1016/j.jacc.2017.02.027

6NURSING
Smith, K. A., & Bigham, M. T. (2013). Cardiogenic shock. The Open Pediatric Medicine
Journal, 7(1). DOI: 10.2174/1874309901307010019
Thiele, H., Ohman, E. M., Desch, S., Eitel, I., & de Waha, S. (2015). Management of
cardiogenic shock. European heart journal, 36(20), 1223-1230.
https://doi.org/10.1093/eurheartj/ehv051
Turagam, M. K., Flaker, G. C., Velagapudi, P., Vadali, S., & Alpert, M. A. (2015). Atrial
fibrillation in athletes: pathophysiology, clinical presentation, evaluation and
management. Journal of atrial fibrillation, 8(4).doi: 10.4022/jafib.1309
Van Herck, J. L., Claeys, M. J., De Paep, R., Van Herck, P. L., Vrints, C. J., & Jorens, P. G.
(2015). Management of cardiogenic shock complicating acute myocardial
infarction. European Heart Journal: Acute Cardiovascular Care, 4(3), 278-
297.https://doi.org/10.1177/2048872614568294
Wu, J. J., Choi, Y. M., & Bebchuk, J. D. (2015). Risk of myocardial infarction in psoriasis
patients: a retrospective cohort study. Journal of Dermatological Treatment, 26(3),
230-234. https://doi.org/10.3109/09546634.2014.952609