Copstead-Kirkhorn: Pathophysiology, 4

th
Edition
Disease Profiles
Cardiogenic Shock
DEFINII!N
A life-threatening condition characterized by insufficient delivery of oxygenated blood to
cells and tissues secondary to decreased contractility, thus resulting in decreased cardiac
output.
EI!"!#$
Cardiogenic shock occurs primarily as a result of severe left and/or right ventricular
dysfunction that results in inadequate cardiac pumping. he most common cause is
myocardial infarction! other causes include cardiomyopathy, ventricular rupture, and
congenital heart defects.

P%&!#ENESIS
"ecreased contractility results in decreased cardiac output, #hich causes decreased
tissue perfusion that is inadequate to meet basal metabolic requirements.
he sympathetic nervous system and renin-angiotensin system are stimulated as
compensatory mechanisms to increase cardiac output. he net result of the activation
of compensatory mechanisms is to increase myocardial oxygen demand. his may
precipitate further myocardial damage, resulting in a progressive decline in cardiac
output.
C"INIC%" '%NIFES%I!NS
$arly signs include increased heart rate #ith maintenance of blood pressure even
though cardiac output has decreased. As compensatory mechanisms fail, the systolic
blood pressure falls and the diastolic pressure increases, causing a narro#ed pulse
pressure.
%ther signs include increased tachycardia! cool, clammy skin! rapid, deep
respirations! pulmonary edema &crackles'! an () gallop! decreased urine output! and
impaired level of consciousness.
(E%'EN I'P"IC%I!NS
herapy is aimed at improving cardiac output and myocardial oxygen delivery #hile
reducing cardiac #orkload.
*edications often include inotropic agents &dopamine, dobutamine, amrinone',
afterload-reducing agents &vasodilators', and preload-reducing agents &venodilators,
diuretics'.
+ntraaortic balloon counterpulsation may be used to reduce afterload and improve
coronary artery perfusion.
,entricular-assist devices may be used for long-term circulatory support, #hereas
heart transplant provides definitive treatment.
$lsevier items and derived items - ./0/, .//1 by (aunders, an imprint of $lsevier +nc.
"isease 2rofiles
KE$ )*ESI!NS
3o# does the body try to compensate for decreased cardiac output during shock
states4
5hat are the cellular and tissue responses to cardiogenic shock4
.