What is the cause of myocardial shock other than Myocardial Infarction?
Correct Answer: All of the above
Description: (D) All of the above[?]Cardiogenic Shock is characteristically shows systemic hypoperfusion due to:oSevere depression of the cardiac index (<2.2/m2)oSustained systolic arterial hypotension (<90mmHg)oElevated filling pressure (pulmonary capillary wedge pressure >18mmHg)oAssociated with in-hospital mortality rates >50%.ETIOLOGIES OF CARDIOGENIC SHOCK & CARDIOGENIC PULMONARY EDEMA[?]Etiologies of Cardiogenic Shock or Pulmonary Edema:oAcute myocardial infarction/ischemia:-LV failure-Ventricular septal rupture-Papillary muscle/chordal rupture - severe MR-Ventricular free wall rupture with subacute tamponade-Other conditions complicating large MIs.oHemorrhage:-Infection-Excess negative inotropic or vasodilator medications.-Prior valvular heart disease-Hyperglycemia/ketoacidosisoPost-cardiac arrestoPost-cardiotomyoRefractory sustained tachyarrhythmiasoAcute fulminant myocarditisoEnd-stage CardiomyopathyoLV apical ballooningoTakotsubo's cardiomyopathyoHypertrophic cardiomyopathy with severe outflow obstruction.oAortic dissection with aortic insufficiency or tamponade.oSevere valvular heart disease:-Critical aortic or mitral stenosis-Acute severe aortic regurgitation or mitral regurgitation.oToxic/metabolic:-Beta blocker or calcium channel antagonist overdose.[?]Other Etiologies of Cardiogenic Shock:oRV failure due to:-Acute myocardial infarction-Acute cor - pulmonaleoRefractory sustained bradyar- rhythmiasoPericardial tamponadeoToxic/metabolic:-Severe acidosis, severe hypoxemia[?]Causes of Cardiogenic Shock - LV failure:oSystolic Dysfunction:-CAD: Acute MI or ischemic (most common cause)-Other conditions: severe myocarditis, end stage cardiomyopathy (including valvular cause), myocardial contusion.-Prolonged cardiopulmonary bypass, global hypoxemia, myocardial depression (beta blocker, calcium blocker, anti-arrhythmic drug), respiratory acidosis.-Metabolic derangement E.g. acidosis, hypoPO4 , Hypo Ca.-Tachycardia related cardiomyopathy.oCardiogenic Shock - Causes:oIntrinsic cardiogenic shock - Myocardial contractility is grossly impaired E.g. Myocardial infarction, myocarditis, Cardiac arrhythmiasoCardiac compressive shock - There is compression of the cardiac chambers and/or great veins, E.g. Cardiac tamponade, tension pneumothorax.oCardiac Obstruction Shock - There is obstruction either in the pulmonary or systemic circulation.-Pulmonary embolism, pulmonary vascular disease.-Mechanical obstruction to aorta, systemic arteriolar constriction.
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