Cardiovascular Critical Care I
LV Failure
| • | Large MI |
|---|---|
| • | Small MI with preexisting systolic HF |
| • | Reinfarction |
| • | Septic shock with severe myocardial depression |
RV Failure
| • | RV infarction |
|---|---|
| • | End-stage pulmonary hypertension |
Acute Mechanical Dysfunction
| • | Papillary muscle rupture or chordal rupture with subsequent severe mitral regurgitation |
|---|---|
| • | Free-wall rupture |
| • | Ventricular septal rupture |
| • | Cardiac tamponade |
Cardiomyopathy
| • | End-stage HF |
|---|---|
| • | Myocarditis |
| • | Peripartum cardiomyopathy |
| • | Left ventricular outflow tract obstruction |
| • | Stress-induced cardiomyopathy (i.e., Takotsubo) |
Valvular Disease
| • | Acute aortic regurgitation |
|---|---|
| • | Ischemic mitral regurgitation |
| • | Aortic or mitral stenosis with tachyarrhythmia or other condition causing decompensation |
| • | Infectious endocarditis |
| • | Prosthetic valve dysfunction or thrombosis |
Arrhythmias
| • | Atrial tachyarrhythmias |
|---|---|
| • | Ventricular tachyarrhythmias |
| • | Bradycardia |
Other Conditions
| • | Prolonged cardiopulmonary bypass and/or coronary air embolus |
|---|---|
| • | Cardiac trauma (blunt or penetrating) |
| • | Heart transplant rejection |
| • | Pulmonary embolism |
| • | Medical nonadherence |
HF = heart failure; LV = left ventricular; MI = myocardial infarction; RV = right ventricular.
Resuscitation/Treatment
Treatment largely depends on managing underlying chronic or acute cardiovascular disease(s) outlined
in Box 1, with consideration given to chronicity of clinical changes before onset of shock.
in sections IV–VII.
Hemodynamic management and pharmacotherapeutic considerations
Because cardiogenic shock may have different underlying, contributing etiologies, hemodynamic
management requires careful interpretation of clinical values. Treatment strategies could be
devised according to the algorithm in Figure 6.