Cardiogenic shock diagnostic criteria: Difference between revisions

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{{Cardiogenic shock}}
{{Cardiogenic shock}}
{{CMG}}; {{AE}} {{AZ}} {{JS}}
{{CMG}}; {{AE}} {{AZ}}; {{JS}}; {{Rim}} {{sali}}


==Overview==
==Overview==
Attending to the catastrophic [[outcome]] of cardiogenic shock in a very short time span, its [[diagnosis]] must be reached as early as possible in order for proper [[therapy]] to be started. This period until [[diagnosis]] and [[therapy|treatment]] initiation is particularly important in the case of cardiogenic shock since the [[mortality rate]] of this condition complicating acute-[[MI]] is very high, along with the fact that the ability to revert the damage caused, through [[reperfusion]] techniques, declines considerably with [[diagnostic]] delays. Therefore and due to the unstable state of these patients, the [[diagnostic]] evaluations are usually performed as supportive measures are initiated. The [[diagnostic]] measures should start with the proper [[medical history|history]] and [[physical examination]], including [[blood pressure]] measurement, followed by an [[EKG]], [[echocardiography]], [[chest x-ray]] and collection of [[blood]] samples for evaluation. The physician should keep in mind the common features of [[shock]], irrespective of the type of [[shock]], in order to avoid delays in the [[diagnosis]]. Although not all [[shock]] patients present in the same way, these features include: abnormal [[mental status]], [[cool extremities]], [[clammy skin]], manifestations of [[hypoperfusion]], such as [[hypotension]] and [[oliguria]], as well as evidence of [[metabolic acidosis]] on the [[blood]] results.<ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref>
Cardiogenic shock is the presence of tissue hypoperfusion secondary to decreased [[cardiac output]] in the context of adequate intravascular volume.


==Diagnostic Criteria==
==Diagnostic Criteria==
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===Clinical Criteria===
===Clinical Criteria===


* Sustained [[hypotension]] for at least 30 minutes defined ad [[systolic blood pressure]] <90 mm Hg, or [[systolic blood pressure]] 30 mm Hg below baseline in preexisting [[hypertension]], or the need for supportive measures to keep the [[systolic blood pressure]] >90 mmHg
* Sustained [[hypotension]] for at least 30 minutes defined as [[systolic blood pressure]] <90 mmHg, or [[mean arterial pressure]] 30 mmHg below baseline in preexisting [[hypertension]], or the need for supportive measures to keep the [[systolic blood pressure]] >90 mmHg
* Clinical evidence of [[hypoperfusion|tissue hypoperfusion]] as manifested by [[oliguria]] (urine output <30 mL/hour), [[cyanosis]], [[cool extremities]], or [[Altered mental status|altered mental status]]
* Clinical evidence of [[hypoperfusion|tissue hypoperfusion]] as manifested by [[oliguria]] (urine output <30 mL/hour), [[cyanosis]], [[cool extremities]], or [[Altered mental status|altered mental status]]
* Presence of [[myocardial]] dysfunction following exclusion or correction of possible non-[[myocardial]] factors contributing to [[hypoperfusion|tissue hypoperfusion]] such as [[hypovolemia]], [[hypoxia]], [[arrhythmia]], and [[acidosis]]<ref name="Califf-1994">{{Cite journal  | last1 = Califf | first1 = RM. | last2 = Bengtson | first2 = JR. | title = Cardiogenic shock. | journal = N Engl J Med | volume = 330 | issue = 24 | pages = 1724-30 | month = Jun | year = 1994 | doi = 10.1056/NEJM199406163302406 | PMID = 8190135 }}</ref><ref name="Hollenberg-1999">{{Cite journal  | last1 = Hollenberg | first1 = SM. | last2 = Kavinsky | first2 = CJ. | last3 = Parrillo | first3 = JE. | title = Cardiogenic shock. | journal = Ann Intern Med | volume = 131 | issue = 1 | pages = 47-59 | month = Jul | year = 1999 | doi =  | PMID = 10391815 }}</ref><ref name="Goldberg-1991">{{Cite journal  | last1 = Goldberg | first1 = RJ. | last2 = Gore | first2 = JM. | last3 = Alpert | first3 = JS. | last4 = Osganian | first4 = V. | last5 = de Groot | first5 = J. | last6 = Bade | first6 = J. | last7 = Chen | first7 = Z. | last8 = Frid | first8 = D. | last9 = Dalen | first9 = JE. | title = Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988. | journal = N Engl J Med | volume = 325 | issue = 16 | pages = 1117-22 | month = Oct | year = 1991 | doi = 10.1056/NEJM199110173251601 | PMID = 1891019 }}</ref>
* Presence of [[myocardial]] dysfunction following exclusion or correction of possible non-[[myocardial]] factors contributing to [[hypoperfusion|tissue hypoperfusion]] such as [[hypovolemia]], [[hypoxia]], [[arrhythmia]], and [[acidosis]]<ref name="Califf-1994">{{Cite journal  | last1 = Califf | first1 = RM. | last2 = Bengtson | first2 = JR. | title = Cardiogenic shock. | journal = N Engl J Med | volume = 330 | issue = 24 | pages = 1724-30 | month = Jun | year = 1994 | doi = 10.1056/NEJM199406163302406 | PMID = 8190135 }}</ref><ref name="Hollenberg-1999">{{Cite journal  | last1 = Hollenberg | first1 = SM. | last2 = Kavinsky | first2 = CJ. | last3 = Parrillo | first3 = JE. | title = Cardiogenic shock. | journal = Ann Intern Med | volume = 131 | issue = 1 | pages = 47-59 | month = Jul | year = 1999 | doi =  | PMID = 10391815 }}</ref><ref name="Goldberg-1991">{{Cite journal  | last1 = Goldberg | first1 = RJ. | last2 = Gore | first2 = JM. | last3 = Alpert | first3 = JS. | last4 = Osganian | first4 = V. | last5 = de Groot | first5 = J. | last6 = Bade | first6 = J. | last7 = Chen | first7 = Z. | last8 = Frid | first8 = D. | last9 = Dalen | first9 = JE. | title = Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988. | journal = N Engl J Med | volume = 325 | issue = 16 | pages = 1117-22 | month = Oct | year = 1991 | doi = 10.1056/NEJM199110173251601 | PMID = 1891019 }}</ref>
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===Hemodynamic Criteria===
===Hemodynamic Criteria===


* Sustained [[hypotension]] for at least 30 minutes defined ad [[systolic blood pressure]] <90 mm Hg, or [[systolic blood pressure]] 30 mm Hg below baseline in preexisting [[hypertension]], or the need for supportive measures to keep the [[systolic blood pressure]] >90 mmHg
* Sustained [[hypotension]] for at least 30 minutes defined as [[systolic blood pressure]] <90 mmHg, or [[mean arterial pressure]] 30 mmHg below baseline in preexisting [[hypertension]], or the need for supportive measures to keep the [[systolic blood pressure]] >90 mmHg
* Depressed [[cardiac index]] (&lt;1.8 L/min/m<sup>2</sup> of [[body surface area|BSA]] without support or &lt;2.0–2.2 L/min/m<sup>2</sup> of [[body surface area|BSA]] with support)
* Depressed [[cardiac index]] (&lt;1.8 L/min/m<sup>2</sup> of [[body surface area|BSA]] without support or &lt;2.0–2.2 L/min/m<sup>2</sup> of [[body surface area|BSA]] with support)
* Elevated [[PCWP|pulmonary capillary wedge pressure]] (&gt;15 mm Hg)
* Elevated [[PCWP|pulmonary capillary wedge pressure]] (&gt;15 mm Hg)

Latest revision as of 19:32, 10 December 2019

Cardiogenic Shock Microchapters

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Overview

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Causes

Differentiating Cardiogenic shock from other Diseases

Epidemiology and Demographics

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Diagnostic Criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]; João André Alves Silva, M.D. [3]; Rim Halaby, M.D. [4] Syed Musadiq Ali M.B.B.S.[5]

Overview

Cardiogenic shock is the presence of tissue hypoperfusion secondary to decreased cardiac output in the context of adequate intravascular volume.

Diagnostic Criteria

Clinical Criteria

Hemodynamic Criteria

References

  1. ↑ 1.0 1.1 Califf, RM.; Bengtson, JR. (1994). "Cardiogenic shock". N Engl J Med. 330 (24): 1724–30. doi:10.1056/NEJM199406163302406. PMID 8190135. Unknown parameter |month= ignored (help)
  2. ↑ Hollenberg, SM.; Kavinsky, CJ.; Parrillo, JE. (1999). "Cardiogenic shock". Ann Intern Med. 131 (1): 47–59. PMID 10391815. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Goldberg, RJ.; Gore, JM.; Alpert, JS.; Osganian, V.; de Groot, J.; Bade, J.; Chen, Z.; Frid, D.; Dalen, JE. (1991). "Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988". N Engl J Med. 325 (16): 1117–22. doi:10.1056/NEJM199110173251601. PMID 1891019. Unknown parameter |month= ignored (help)
  4. ↑ Forrester, JS.; Diamond, G.; Chatterjee, K.; Swan, HJ. (1976). "Medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts)". N Engl J Med. 295 (24): 1356–62. doi:10.1056/NEJM197612092952406. PMID 790191. Unknown parameter |month= ignored (help)
  5. ↑ Forrester, JS.; Diamond, G.; Chatterjee, K.; Swan, HJ. (1976). "Medical therapy of acute myocardial infarction by application of hemodynamic subsets (second of two parts)". N Engl J Med. 295 (25): 1404–13. doi:10.1056/NEJM197612162952505. PMID 790194. Unknown parameter |month= ignored (help)
  6. ↑ Reynolds, HR.; Hochman, JS. (2008). "Cardiogenic shock: current concepts and improving outcomes". Circulation. 117 (5): 686–97. doi:10.1161/CIRCULATIONAHA.106.613596. PMID 18250279. Unknown parameter |month= ignored (help)


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