Shock Solution 4

A 56 year old male presents to ER. He is cold, clammy, dysphoric and complaining of central chest pain. His pulse is 130, blood pressure is 84/50, lung fields: bilateral crackles, a third heart sound is audible. ECG reveals ST segment elevation leads V2 to V4
 

The diagnosis is cardiogenic shock secondary to acute myocardial infarction. There is both systolic (forward) and diastolic (backward) failure. The heart muscle is unable to eject the end diastolic volume, stroke volume falls and the body behaves as if it is reacting to hypovolemia with vasoconstriction and fluid retention. The cardiac output is low, the peripheral resistance is high.

The management is: Oxygen therapy, minimal 40%, intravenous morphine and aspirin 325mg to chew. Ideally thrombolysis or percutaneous angioplasty is performed, to reperfuse ischemic myocardium – hopefully re-establishing muscle functionality. If this fails, then intra-aortic balloon counterpulsation or dobutamine may be required.

DX: cardiogenic shock due to pump failure.