Many causes. Heart attack, acute myocarditis and stress induced cardiomyopathy can all cause weakness of heart pump and cardiogenic shock. Acute valve problems or dysruption of heart muscle can happen with heart attacks and infection of the heart (endocarditis) and cause cardiogenic shock. Severe heart rhythm problems can also cause ineffective heart pump function and cardiogenic shock.
Low cardiac output. Cardiogenic shock occurs because of a low output state causing significant low blood pressure. The decrease in cardiac output results from congestive heart failure and or an abrupt insult the cardiac muscle resulting in less cardiac function and this less output. The management involves mess lie, dobutamine, as well as BP raising rx such as Dopamine or levophed (norepinephrine). Balloon pump insertion may help.
Mother had lupus and died suddenly of autoimmune hemolytic anemia that caused cardiogenic shock. Is that a lupus thing or do I need 2 worry. I have ra?
Not a concern. Rheumatoid arthritis is a strikingly different entity from systemic lupus and if you are sure this is what you have, you need to work hard managing this rather than lupus. Rheumatoid arthritis can cause modest hemolysis by hypersplenism but not the catastrophic autoimmune hemolysis sometimes seen in lupus.
Lupus. Autoimmune hemolytic anemia can be part of lupus. You so not have to worry about aha if you have RA however.
Bad. Inadequate pumping resulting in low blood pressure, underperfusion of vital organs leading to multiorgan failure, with lung congestion, renal impairment, liver dysfunction, and reduced mentation.
Multimodal. Treat the underlying cause first. Generally, we give medication that increase the heart's ability to pump effectively. We try to remove excess fluid from circulation with diuretics. We can also reduce the constriction in the arteries, making it easier for the heart to pump (less resistance.) We often monitor these treatments with catheters in the radial artery and vena cava.
Depends. Greatly on situation. Talk to ICU or ccu physicians.
Norepi, probably. Norepinephrine or Dopamine would be typical first line choices to treat the hypotension and hypoperfusion of cardiogenic shock. Would guide further additions and titration with swan ganz catheter and arterial line. Titration depends on cardiac function, patient's comorbidities, and arrhythmias from inotrope.
Dopamine. Dopamine is used when blood pressure and cardiac output are severely compromised and the risks of using the drug are exceeded by the potential benefits.
See below: Although heart attacks (when 1 or more of the coronary arteries become blocked) are the most common cause, cardiogenic shock can also be due to other conditions, such as inflammation of the heart muscle (myocarditis) or infection of the heart valves (endocarditis). Other causes include drug overdoses or poisoning with subtances that can affect a heart's pumping ability.
CCU management. Ccu management to optimize tissue and cardiac perfusion. Aim should be to optimize oxygenation and blood pressure such that vital organs survive. Investigate causes (include mi, arrhythmia, acute valvular dysfunction, chf, or a systemic problem that has destabilized a tenuous chronic cardiac condition like cardiomyopathy.
Not directly. Talk to your doctor about keeping your dm under control.