Name: __________________________________________

Cardiogenic Shock
occurs when the heart has an impaired pumping
ability
it may be of coronary or non-coronary event
origin
Coronary cardiogenic shock occurs when a
significant amount of the left ventricular
myocardium has been damaged
e.g. patients who experience anterior wall
myocardial infarction
Non-coronary cardiogenic shock related to
conditions that stress the myocardium, as well as
conditions that result in ineffective myocardial
function
e.g. severe hypoxemia, acidosis, hypoglycaemia,
hypocalcemia,
and
tension
pneumothorax;
cardiomyopathies, valvular damage, cardiac
tamponade, dysrhythmias

Pathophysiology of Cardiogenic Shock

Medical-Surgical Nursing: Cardiogenic Shock

By: Group 2
Clinical Manifestations
Patients in cardiogenic shock may experience:
pain in angina
develop dysrhythmias
hemodynamic instability
Medical Management
The goals of medical management in cardiogenic
shock are:
1. to limit further myocardial damage and
preserve the healthy myocardium; and
2. to improve the cardiac function by increasing
cardiac contractility, decreasing ventricular afterload, or
both
In general, these goals are achieved by increasing oxygen
supply to the heart muscle while reducing oxygen
demands.
Medical Management (cont)
Correction of Underlying Causes
Initiation of First-Line Treatment
Pharmacologic Therapy
Mechanical Assistive Devices

Name: __________________________________________

Medical-Surgical Nursing: Cardiogenic Shock

By: Group 2

Correction of Underlying Causes

- Underlying cause of cardiogenic shock must be
corrected
- Treat the oxygenation needs of the heart muscle
to ensure its continued ability to pump blood to
other organs
- In case of coronary cardiogenic shock, patient
may require thrombolytic therapy, angioplasty,
coronary artery bypass graft surgery, intraaortic balloon pump therapy
- For
non-coronary
cardiogenic
shock,
interventions focus on the correcting the
underlying cause, such as replacement of a faulty
cardiac valve, correction of dysrhythmia,
correction of acidosis and electrolyte
disturbances, or treatment of the tension
pneumothorax
Initiation of First-Line Treatment
- Supplying supplemental oxygen
Supplemental oxygen is administered by
nasal cannula at a rate of 2 to 6 L/min to
achieve oxygen saturation exceeding
90%
- Controlling chest pain
IV morphine sulphate is administered for
pain relief and dilates blood vessels
- Providing selected fluid support
- Administering vasoactive medications
- Controlling heart rate with medication or by
implementation of a transthoracic or IV
pacemaker
- Implementing mechanical cardiac support
(intra-aortic balloon counterpulsation therapy,
ventricular assist systems, or extracorporeal
cardiopulmonary bypass [CPBI]
Pharmacologic Therapy
- In coronary cardiogenic shock, vasoactive
medication
therapy
improves
cardiac
contractility, decrease preload and afterload,
and stabilize heart rate and rhythm
Two types of medication:
Sympathomimetic agents increase cardiac
output by mimicking the action of the sympathetic
nervous system through vasoconstriction
Vasodilators used to decrease overload and
afterload, thus reducing the workload of the heart
and the oxygen demand

Medications commonly combined to treat

cardiogenic shock include: dobutamine, dopamine,
and nitroglycerin.
Mechanical Assistive Devices
- are used temporarily to improve the hearts
ability to pump
- e.g. intra-aortic balloon counterpulsation, left
and right ventricular assist device, total
temporary artificial hearts, extracorporeal
device
Nursing Management
Preventing cardiogenic shock
Monitoring hemodynamic status
Administering medications and intravenous
fluids
Maintaining
intra-aortic
balloon
counterpulsation
Enhancing safety and comfort
Preventing Cardiogenic Shock
- Promote adequate oxygenation of the heart
muscle
- Decrease cardiac workload
Monitoring Hemodynamic Status
- Arterial lines and ECG monitoring equipment
must be well maintained and functioning
properly
- Report changes in hemodynamic, cardiac, and
pulmonary status and lab values, adventitious
breath sounds, cardiac rhythm, and other
findings
Administering Medications and Intravenous Fluids
- Monitor patient for decreased BP after giving
morphine or nitroglycerin
- Monitor patients given with thrombolytic
therapy for bleeding
- Closely monitor IV infusions because tissue
necrosis and sloughing may occur
- Urine output, BUN, and serum creatinine levels
are monitored to detect decreased renal function
Maintaining Intra-aortic Balloon Counterpulsation
- Make ongoing timing adjustments of the balloon
pump to maximize its effectiveness by
synchronizing it with the cardiac cycle
Enhancing Safety and Comfort
- Administer pain reliever for chest pain
- Proper positioning of the client promotes
effective breathing without decreasing BP