Question

Ms. X's condition becomes less stable and she remains in the hospital. On the seventh day following admission, she is found unconscious on the floor of her bathroom. Her pulse is weak and elevated, and her skin is moist with pallor evident. Her BP is 50 systolic. A diagnosis of cardiogenic shock is made and resuscitation efforts are started. 10. Explain why Ms. X. has experienced cardiogenic shock at 11. Describe the effects of cardiogenic shock on the organs 12. What problems will occur if decompensated shock 13. Ms. X dies shortly later. What is the cause of death in this this time. of the body occurs? How is compensation limited in this situation? case?

Answer 1

Cardiogenic shock is a physiologic state in which inadequate tissue perfusion results from systolic cardiac dysfunction.

10.

in case of Ms.X, she was unstable for 6 days. but the actual cause is unknown.in most cases, the reason would be low-cardiac-output state secondary to extensive left ventricular (LV) infarction, followed by a mechanical defect like ventricular septal defect or papillary muscle rupture or right ventricular (RV) infarction.

if it is due to cardiogenic cause, pathophysiology would be due to low systolic pressure, the volume of blood ejected from the ventricle reduces. thus, end -systolic volume will increases later results in increased diastolic filling and increased LV end-diastolic pressure.this attempt to raise cardiac output, however, increases myocardial oxygen demand and can lead to pulmonary oedema. As a result of decreased contractility, the patient develops elevated Left ventricular and Right Ventricular filling pressures and low cardiac output. Mixed venous oxygen saturation falls because of the increased tissue oxygen extraction, which is due to the low cardiac output, contributes to substantial arterial oxygen desaturation.

11.

During shock, acute systemic hypoperfusion leads to tissue hypoxia and dysfunction of vital organs. cellular hypoxia and end-organ damage caused by decreased blood flow to end organs. The vital organ affected by this are brain, heart and kidney.A decreased cardiac output results in diminished perfusion of the brain, which leads to an altered mental status ranging from confusion and agitation to flaccid coma. Depressed coronary perfusion leads to worsening cardiac dysfunction and leads to hypoperfusion. Renal compensation for reduced perfusion results in diminished glomerular filtration, causing oliguria and subsequent renal failure.

12.

`symptoms of decompensated shock

falling systolic blood pressure

• tachycardia and tachypnea
• low urine output
• laboured or irregular breathing
• weak, thready or absent peripheral pulse
• cyanosis
• reduced body temperature
• dilated pupils
• decreased mental status

with decompensated shock (shock become worse), advanced life support is needed to rescue a patient. and priority should be given to airway and underlying cause of shock. If the condition remains untreated, shock becomes irreversible and leads to the death of the patient.

13.

here, the patient died because she did not get adequate treatment on a rapid basis. A rapid response is a key to the successful treatment of shock, requires a speedy assessment and quick transport to emergency care.