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CARDIOGENIC SHOCK,Aditya Badheka, PL-1,Etiology,Pump Failure Ductal dependent lesions Myocardial failure myocarditis cardiomyopathy electrolyte abnormalities ischemia Restrictive: Tamponade Abnormalities in heart rate,PHYSIOLOGIC PRINCIPLES,Frank-Starling Phenomenon Cardiac Output Oxygen delivery and utilization,Frank-Starling Phenomenon,“In the normal heart, the diastolic volume (preload) is the principal force that governs the strength of ventricular contraction.”,Otto Frank and Ernest Starling,Cardiogenic Shock,Cardiac output is inadequate to meet tissue demands Phases: Early, compensated Late, uncompensated Hypotension and bradycardia are the signs,C.O. = Stroke volume x Heart rate,Stroke volume: Preload Myocardial contractility Afterload: systemic and pulmonary resistance blood viscosity Heart Rate Bradycardia Sustained tachycardia,Acute Myocarditis - Definition,A process characterized by inflammatory infiltrates of the myocardium, with necrosis and/or degeneration of myocytes which is very different from the ischemic damage observed in ischemic heart disease.,CAUSES OF MYOCARDITIS,Infectious: Viral: adenovirus (2&5), enterovirus, CMV, RSV Bacterial: meningococcus, TB, Legionella, Leptospira Rickettsial Protozoal: T. cruzi Non-infectious: toxic, drugs, hypersensitivity/ autoimmune,Clinical Presentation of Myocarditis,PATHOPHYSIOLOGY OF MYOCARDITIS THE DOMINO EFFECT,Ischemic Heart Disease in Children,ALCAPA Anomalous Left Coronary Artery arising from the Pulmonary Artery Kawasaki Disease Aneurysms Other vasculitis,Electrolyte/Metabolic Abnormalities,Hyperkalemia Hypocalcemia Hypermagnesemia Hypoxia Metabolic Acidosis,VENTRICULAR FUNCTION CURVES NORMAL AND FAILING LV,Cardiogenic Shock - Arrhythmias,Check pulses: rapid Check EKG,SVT,Cardiogenic Shock High Afterload,Tamponade: pulsus paradoxus Pulmonary hypertension massive PE High or low Systemic Vascular Resistance Septic shock LV failure from chronic hypertension,Signs and Symptoms,Shocky, but no history of volume loss Vital signs: tachycardia, hypotension Poor perfusion WHEEZING Metabolic acidosis Heart size on CXR may be normal,MANAGEMENT ABCS,Airway and breathing Circulation fluid bolus ? inotropic support,What May be Harmful?,Albuterol Diuretics Fluid restriction,CARDIOGENIC SHOCK INOTROPIC AGENTS,Dobutamine Dopamine Epinephrine Milrinone Norepinephrine Digoxin Vasopressin (?),Management,Tamponade Fluid bolus Increase heart rate Pericardiocentesis SVT Vagal maneuvers Adenosine Cardioversion Correct electrolyte abnormalities,CARDIOGENIC

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