eMedicine Specialties > Emergency Medicine > Cardiovascular

Shock, Cardiogenic: Follow-up

Author: Ethan S Brandler, MD, MPH, Clinical Assistant Professor, Attending Physician, Departments of Emergency Medicine and Internal Medicine, University Hospital of Brooklyn, Kings County Hospital
Coauthor(s): Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Contributor Information and Disclosures

Updated: Oct 30, 2009

Follow-up

Further Inpatient Care

  • All patients require admission to an intensive care setting, which may involve emergent transfer to the cardiac catheterization suite, critical care transport to a tertiary care center, or internal transfer to the ICU.

Transfer

  • By definition, these patients are in shock, and their condition is unstable. Attempts to transfer the patient must be made only when everything possible has been done to stabilize their condition, when the level of care during the transfer does not significantly decrease, and when a higher level of care is available at the transfer location. Remember that survival is best when PCI is performed early.

Deterrence/Prevention

  • Although cardiogenic shock is not entirely preventable, measures can be taken to minimize the risk of occurrence, recognize it at earlier stages, and begin corrective therapy more expeditiously. Deterrence and prevention require a high degree of suspicion and heightened awareness.
  • Care is required in treating patients with acute coronary syndromes not yet in cardiogenic. Careful use of beta-blockers and ACE inhibitors in these patients is essential to avoid hypotension leading to cardiogenic shock.5

Complications

  • Cardiopulmonary arrest
  • Dysrhythmia
  • Renal failure
  • Multisystem organ failure
  • Ventricular aneurysm
  • Thromboembolic sequelae
  • Stroke
  • Death

Prognosis

  • The mortality rate is more than 55% in patients treated medically. At best, the rate is 38% in those in whom surgical reperfusion is achieved.
  • Evidence of right ventricular dilation on echocardiogram may indicate worse outcomes.
  • Evidence of right ventricular infarction on a right-sided electrocardiogram may also indicate worse outcomes.8

Patient Education

  • Patients should be educated regarding the early warning signs of AMI and how to access the emergency medical system (eg, calling 911).
  • Patients also must be educated regarding cardiac risk factors, particularly those that are reversible and subject to change (eg, smoking, diet, exercise).
  • For excellent patient education resources, visit eMedicine's Shock Center and Public Health Center. Also, see eMedicine's patient education articles Shock and Cardiopulmonary Resuscitation (CPR).

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize cardiogenic shock in the early stages before severe decompensation occurs
  • Failure to consult a cardiologist early to obtain early
  • Failure to focus on revascularization, which delays reperfusion
  • Failure to give sufficient volume (eg, RV infarct without evidence of pulmonary edema)
  • Failure to consider other potentially reversible or contributory causes of shock (eg, valvular dysfunction, tamponade)
  • Failure to adequately resuscitate the patient prior to transfer
  • Failure to have an appropriately trained transport team transfer the patient
 


More on Shock, Cardiogenic

Overview: Shock, Cardiogenic
Differential Diagnoses & Workup: Shock, Cardiogenic
Treatment & Medication: Shock, Cardiogenic
Follow-up: Shock, Cardiogenic
Multimedia: Shock, Cardiogenic
References
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References

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Further Reading

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Keywords

cardiogenic shock, cardiac shock, shock, global hypoperfuse, acute myocardial infarction, AMI, decreased pumping of the heart, decreased urine output, altered mentation, hypotension, jugular venous distension, cardiac gallop, pulmonary edema, acute cardiac ischemia

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Contributor Information and Disclosures

Author

Ethan S Brandler, MD, MPH, Clinical Assistant Professor, Attending Physician, Departments of Emergency Medicine and Internal Medicine, University Hospital of Brooklyn, Kings County Hospital
Ethan S Brandler, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Daniel J Dire, MD, FACEP, FAAP, FAAEM, Clinical Professor, Department of Emergency Medicine, University of Texas-Houston; Clinical Professor, Department of Pediatrics, University of Texas Health Sciences Center, San Antonio, Texas
Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US
Disclosure: Talecris Biotherapeutics Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon
A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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