PATHOPHYSIOLOGY OF CARDIOGENIC SHOCK FROM DECOMPENSATED HEART

FAILURE; CONGENITAL HEART DISEASE; VENTRICULAR SEPTAL DEFECT;

LEGEND: NYHA FC IV; CAP-MR, DOWN SYNDROME
Precipitating/Predisposing Factors
Modifiable Factors:
Disease Process
Non-modifiable Factors: • Chronic Smoking
Laboratory & Diagnostic Tests
• Unhealthy Lifestyle
Signs & symptoms • Family History: CAD
• Hypertension
Complications • Down Syndrome (50% of VSD are
from Trisomy 21) • Obesity
Treatment/Management (L) Ventricular Septal Defect at birth
• Ventricular Septal Defect (28-42% • Diabetes Mellitus
Manifested by Patient of CHD are VSD • Medication
• CKD Stage IV • Poor Prenatal Care
• Gender: Female (13.5%) ↑ O2 saturation Left-Right heart shunting
• Maternal alcohol ingestion
Holosystolic murmur (30% risk)

Right-Left heart shunting

↓ O2 saturation: 87%
Central cyanosis (Eisenmenger Syndrome)

June 14, 2023

Left ventricular filling with deoxygenated • ↓ Hemoglobin - 99 g/L
blood • ↓ Hematocrit - 0.33 L/L
• ↓ RBC - 3.8 x 10^12/L

Deoxygenated blood pumped through

the rest of the body

Hypoperfusion at kidneys
Normal compensatory mechanism:
Irreversible loss of ↑ Heart contractility
nephrons

June 14:
Damage to heart muscles
↑ BUN (11.0) ↓ GFR Angiotensin II
↑ Creatinine (197.40)

Remaining nephrons DECOMPENSATED HEART FAILURE NYHA FC IV

↑ Chloride 110.07mmol/L
June 14: perform normal function
GFR: 27 mg/dl
I & O monitoring
VS q 4hrs Oliguria: 350 Decline in contractile power Furosemide 20 mg IV OD
Glomerular capillary Cardiac UTZ (03-17-23)
hypertension
Cardiac monitoring
↓ Stroke volume
↑ Glomerular permeability
and filtration
↓ Cardiac output
June 14:
Renal scarring ↓ Hgb
↓ Hct June 14: 80/50 mmHg Norepinephrine @2 cc/hr. to
↓ RBC ↓ Blood pressure
June 15: 70/60 mmHg maintain SBP >100/90
↑ WBC
Ultrasound whole abdominal CHRONIC KIDNEY PNSS 1L @30gtts/min.
↑ Neutrophils
pelvic (03-17,2013): Renal DISEASE STAGE 4 ↓ Lymphocytes
parenchymal disease, Grade 1
↓ Eosinophils
Release of catecholamines ↑ ADH Angiotensin II
↑ APTT
ABG Analysis
Repeat laboratories Vasoconstriction Sodium retention
Vasoconstriction ↑ Heart rate ↑ Contractility

↑ Fluid retention

Failure of compensatory
mechanism

↑ Myocardial oxygen requirements

↓ Cardiac output
↓ Ejection fraction

O2 sat: 87% O2 via face mask at 10 L/mL

↓ Tissue perfusion Pallor
Tachycardia Intubation
(117 bpm)
Impaired cellular metabolism

CARDIOGENIC SHOCK

Heart Brain Kidney Skin Lungs

↓ Coronary perfusion ↓ Blood flow ↓ Blood flow to renal system Vasoconstriction at Failure of heart to put out all
extremeties the venous blood returned
Aggressive Cerebral hypoxia Progressive injury to already
Myocardial ischemia behavior pre-existing chronic kidney Cold clammy skin Blood from left ventricles back
damage Poor skin turgor with >3 up into the lungs
Trimetazidine 300 mg Chest pain May do restraints Progressive ↓ LOC secs recoil of skin
radiating to left Xerosis
tab BID
↓ GFR Renal ischemia Pulmonary hypertension
June 14:
GCS 12 Azithromycin 500 mg/
Fatigue ↑ Creatinine Oliguria ATN tab 1 tab PO now then
Chest x-ray
↓ Muscle tone Bilateral pneumonia (03-17-23) OD x 3 days
Ceftriaxone 2gm IVTT
now then OD
Crackles Tachypnea Dyspnea
DOB NPO
NGT
Use of accessory Omeprazole 40
DAT
muscles mg IV OD
with SAP
Moderate HBR

End stage organ failure

DEATH