Cardiogenic Shock - Northwestern Cardiology Fellows Homepage：心源性休克-西北心脏病学研究员主页.pptVIP

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2018-05-30 发布于浙江
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Cardiogenic Shock - Northwestern Cardiology Fellows Homepage：心源性休克-西北心脏病学研究员主页.ppt

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Cardiogenic Shock and Hemodynamics Outline Overview of shock Hemodynamic Parameters PA catheter, complications Differentiating Types of Shock Cardiogenic Shock Etiologies Pathophysiology Clinical Findings Treatment SHOCK= Inadequate Tissue Perfusion Mechanisms: Inadequate oxygen delivery Release of inflammatory mediators Further microvascular changes, compromised blood flow and further cellular hypoperfusion Clinical Manifestations: Multiple organ failure Hypotension Hemodynamic Parameters Systemic Vascular Resistance (SVR) Cardiac Output (CO) Mixed Venous Oxygen Saturation (SvO2) Pulmonary Capillary Wedge Pressure (PCWP) Central Venous Pressure (CVP) Normal Values Differentiating Types of Shock PA Catheter Complications Path of PAC: central venous circulation ? R heart? pulmonary artery. The proximal port is in R atrium, distal port in pulm artery Arrhythmias RBBB PA rupture PAC related infection Pulmonary infarction Cardiogenic Shock Systemic hypoperfusion secondary to severe depression of cardiac output and sustained systolic arterial hypotension despite elevated filling pressures. Cardiogenic Shock Etiologies Pathophysiology Clinical/Hemodynamic Characteristics Treatment Options Etiologies Acute myocardial infarction/ischemia? LV failure? VSR? Papillary muscle/chordal rupture- severe MR Ventricular free wall rupture with subacute tamponade? Other conditions complicating large MIs?? Hemorrhage ?Infection?? Excess negative inotropic or vasodilator medications?? Prior valvular heart disease?? Hyperglycemia/ketoacidosis Post-cardiac arrest Post-cardiotomy Refractory sustained tachyarrhythmias Acute fulminant myocarditis End-stage cardiomyopathyHypertrophic cardiomyopathy with severe outflow obstruction Aortic dissection with aortic insufficiency or tamponade Pulmonary embolu Severe valvular heart disease?-Critical aortic or mitral stenosis, Acute severe aortic or MR Pathophysiology Clinical Findings Physical Exam: elevated JVP, +S3, rales, oliguria, acute pu