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Cardiogenic Shock
Clinical Features
The presence of shock following myocardial infarction implies the loss of a large area of myocardium and carries an extremely high mortality (>80% in hospital).
- Consider immediate angioplasty and insertion of aortic balloon pump if feasible.
- If inferior MI consider RV infarction. Check RV leads on 12-lead ECG.
- Consider emergency echo (contact Cardiologist). This will identify the cause of the hypotension and guide treatment (RV infarction, LV infarction, acute VSD, acute papillary rupture, tamponade).
- Consider inotropes, e.g., dobutamine or dopamine. See Inotropic Support for infusion details. Discuss with Cardiologist.
- About 20% of patients with cardiogenic shock have low LV filling pressures (e.g., RV infarction or patients on diuretic therapy) and may benefit from fluid infusions (250 mL bolus 0.9% sodium chloride, repeated if necessary up to 2000 mL). These patients do not have pulmonary oedema. Swan-Ganz monitoring may be helpful.
- Consider early aortic balloon counter pulsation and coronary angioplasty with an acute myocardial infarction.
- Treat any arrhythmias.
- Consider other possible causes, e.g., sepsis, pulmonary embolism.
Topic Code: 1323