What is the cause of myocardial shock other than Myocardial Infarction?
Acute severe mitral regurgitation
Ventricular septal rupture
Isolated right ventricular shock
All of the above
(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.
C.V.S.