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Cardiogenic Shock

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Cardiogenic Shock

Summary of Pathophysiology Occurring in this Patient

Several pathophysiology functions are related to the current conditions of this patient, as

evidenced by echocardiography, coronary angiography, and lab table diagnosis. First, this patient

has regional wall motion abnormalities as per the echocardiography, which involves or becomes

subjective abnormalities to the region of the heart muscle. The echocardiography examination

also shows that this patient has issues of moderate mitral regurgitation, which is mainly

associated with heart valve illnesses in which there are complexities in closing or a backward

blood leak across the left heart chamber. In addition, an echocardiography examination also

shows that this patient has pathophysiology associated with a rise in ejection fraction as per the

current imaging, which shows about 40%-50% from approximately 25-35% for the last six

months. The second examination involved a repetitive coronary angiography, whereby the

patient showed an appreciation of multi-vessel coronary artery disease, which is not amenable to

percutaneous coronary intervention (PCI). Arguably, there is a significant concern with this

patient considering further lab table examination results after transferring it to the stretcher

because the patient converted it to fibrillation and cardiopulmonary arrest. This also shows that

this patient was pallid, cold to the touch, and had diffuse rhonchi in addition to three pitting

edemata within the lower extremities.

Discussion of Anticipated Invasive Monitoring Strategies for this Patient and His Expected

Hemodynamic Parameters

The invasive monitoring strategy that should be undertaken for this patient is Invasive

Hemodynamic Monitoring (IHM) (Magder, 2017). The IHM helps measure a patient's blood

volume as it enters or moves through the heart into the bloodstream and helps show the intensity
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or how the heart works. While it is regarded as an invasive monitoring approach, it is mainly

used in cases of severe and longtime heart problems. This is evidenced by the patient’s

abovementioned pathophysiology that this patient shows an appreciation of multi-vessel

coronary artery disease, which is not amenable to percutaneous coronary intervention, calling for

continuous IHM. The non-invasive strategy that would effectively apply in monitoring this

patient is a bio-impedance, which helps in sharing physical principles with bio-reactance. It

involves the delivery of a low-amplitude and frequency electric current to receive voltage by the

electrode. The output signal further helps identify stroke volume and thoracic fluid content.

Arguably, the blood flow through the aorta is considered to decrease over time due to an increase

in iron and water in the chest, thus raising the blood volume. This non-invasive monitoring

approach is effective for this patient owing to his rise in ejection fraction as per the current

imaging.

The expected hemodynamic parameters for this patient are the heartbeat or pulse rate and blood

pressure, considering his current complexities. An invasive pulmonary artery catheter for the

IHM approach selected above will determine this. Arguably, heartbeat hemodynamics will

reflect how blood flows through the main arteries of this patient and the heart's force to allow the

very flow. In addition, blood pressure hemodynamic parameters result from a non-invasive

monitoring process, purposely showing the cardiac output, blood flow, and systemic vascular

resistance.

Management of the Patient

The management decision proposed for this patient is to relieve the adversity of the

existing symptoms of cardiogenic shock and at the same time, alleviate future cardiac events.

First, the medication and diagnostic examinations undertaken for this patient show that he has
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other indirect abnormalities that might have emanated from the adverse effect of the existing

coronary disease, including edema and type two diabetes (Safri, 2018). The decision above will

incorporate a medication approach since the patient is incubated to alleviate the adversity of the

cardiac shock. The management decision is a planned treatment for various pathophysiology

complexes identified in the first section, mainly those relating to the given medication (Thiele et

al., 2019). Among the medication to include for general and continuous treatment of this patient

include Glyburide 10 mg, isosorbide mono-nitrate 80 mg daily, spironolactone 100 mg daily,

digoxin 0.25 mg daily, furosemide 120 mg daily, enalapril 20 mg daily, and ASA 81 mg daily as

per the requirements. Glyburide 10 mg will help treat blood sugar levels, which are mainly

associated with type 2 diabetes. Isosorbide mono-nitrate 80 mg daily helps treat chest pain or

angina, and enalapril 20 mg applies to maintain this patient’s blood pressure. In addition, ASA

81 mg will be given to the patient to control heart attacks and related effects.
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References

Magder, S. (2017). Invasive intravascular hemodynamic monitoring: technical issues. Critical care

clinics, 23(3), 401–414.

Safri, Z. (2018, March). Management of coronary artery disease. In IOP Conference Series:

Earth and Environmental Science (Vol. 125, No. 1, p. 012125). IOP Publishing.

Thiele, H., Ohman, E. M., Desch, S., Eitel, I., & de Waha, S. (2019). Management of cardiogenic

shock. European heart journal, 36(20), 1223-1230.