{"id":9622,"date":"2021-12-28T17:54:54","date_gmt":"2021-12-28T15:54:54","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acute-heart-failure-cardiogenic-shock\/"},"modified":"2021-12-30T00:23:38","modified_gmt":"2021-12-29T22:23:38","slug":"acute-heart-failure-cardiogenic-shock","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acute-heart-failure-cardiogenic-shock\/","title":{"rendered":"Acute heart failure, cardiogenic shock"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Acute heart failure<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Heart failure is a syndrome in which the heart cannot meet the body&#8217;s circulatory demands under physiological conditions.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Acute heart failure<\/strong> is defined as a rapid onset of a new, or worsening signs and symptoms of HF.<\/li><li>In most cases, due to LV dysfunction.<\/li><li>Most commonly, AHF occurs as an <strong>exacerbation of an existing chronic heart failure<\/strong> (<strong>acute decompensated heart failure<\/strong>); typically, due to an MI, excessive salt intake, sudden discontinuation of medications, or tachyarrhythmias.<\/li><li>AHF can lead to congestion and hypoperfusion, with the following:<ul><li>Peripheral edema and dilated veins<\/li><\/ul><ul><li>Pulmonary hypertension, presenting as severe dyspnea and orthopnea, and coughing up of pink sputum<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>Acute MI and ischemia<\/li><li>Acute and severe HTN<\/li><li>Acute renal failure<\/li><li>Valvular disease<\/li><li>Arrhythmias<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Classification<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">Patients can be classified based on their clinical presentation:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Based on the presence of congestion: no (&#8220;<strong>dry<\/strong>&#8220;) \/ yes (&#8220;<strong>wet<\/strong>&#8220;)<\/li><li>Based on hypoperfusion: no (&#8220;<strong>warm<\/strong>&#8220;) \/ yes (&#8220;<strong>cold<\/strong>&#8220;)<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The treatment plan can be adjusted based on these findings. Most patients appear with congestion and no hypoperfusion (wet and warm).<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Cardiac enzymes (CK-MB, cTn, BNP, NT-proBNP) are all elevated<\/li><li>ECG may appear with:<ul><li>P-pulmonale<\/li><li>Pathological Q waves, ST-elevation\/depression, T-wave inversion<\/li><\/ul><\/li><li>Chest x-ray<\/li><li>Echocardiography<\/li><li>Arterial blood gas<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">The purpose is to stabilize the patient and decrease the preload:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Oxygen<\/li><li>Diuretics (furosemide; most important)<\/li><li>Nitrates<\/li><li>Dobutamine if pulmonary edema persists (digoxin takes weeks to work)<\/li><li>Salt and fluid restriction<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Cardiogenic shock<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">Shock is defined as an acute collapse of blood circulation causing hypoperfusion.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Cardiogenic shock<\/strong> is caused by a dysfunction of the heart, when it cannot generate sufficient output. <strong>It is the most severe presentation of acute heart failure<\/strong>.<\/li><li>Presents with weakness and paleness, cold extremities, dilated veins and elevated JVP, pulmonary congestion (dyspnea), low BP (systolic &lt;90), low urine output.<\/li><li>Most often occurs due to an acute MI; other causes include arrhythmias, injury and cardiac temponade, valcular disorders.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<ul class=\"wp-block-list\"><li>Cardiac enzymes<\/li><li>ECG demonstrating ischemia or arrhythmia<\/li><li>Echocardiography<\/li><li>Swan-Ganz catheter (monitoring pulmonary artery pressure, cardiac output)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li>Treatment of the cause<\/li><li>Preload &amp; afterload reduction<ul><li>Loop diuretics in volume overload, dialysis in renal failure, nitrates<\/li><li>Hydralazine<\/li><\/ul><\/li><li>Inotropic agents (dobutamine, dopaline, and NE)<\/li><li>Devices<ul><li>Intra-aortic balloon pump (places in the descending aorta; inflates during diastole, and deflates during systole)<\/li><li>Ventricular assist devices (LVAD, RVAD, BiVAD)<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">References<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5597697\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5597697\/<\/a><\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Acute heart failure<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Etiology<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Cardiogenic shock<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">References<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Acute heart failure Heart failure is a syndrome in which the heart cannot meet the body&#8217;s circulatory demands under physiological conditions. Acute heart failure is defined as a rapid onset of a new, or worsening signs and symptoms of HF. In most cases, due to LV dysfunction. Most commonly, AHF occurs as an exacerbation of [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":14,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9622","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Acute heart failure, cardiogenic shock &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acute-heart-failure-cardiogenic-shock\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/acute-heart-failure-cardiogenic-shock\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/acute-heart-failure-cardiogenic-shock\\\/\",\"name\":\"Acute heart failure, cardiogenic shock &#8211; Meddists\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/#website\"},\"datePublished\":\"2021-12-28T15:54:54+00:00\",\"dateModified\":\"2021-12-29T22:23:38+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/acute-heart-failure-cardiogenic-shock\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/acute-heart-failure-cardiogenic-shock\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/acute-heart-failure-cardiogenic-shock\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"http:\\\/\\\/meddists.com\\\/learn\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Clinical\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Internal medicine\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Cardiology\",\"item\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/\"},{\"@type\":\"ListItem\",\"position\":5,\"name\":\"Acute heart failure, cardiogenic shock\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/#website\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/\",\"name\":\"Meddists\",\"description\":\"Let&#039;s Get Studying\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/meddists.com\\\/learn\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Acute heart failure, cardiogenic shock &#8211; Meddists","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acute-heart-failure-cardiogenic-shock\/","twitter_misc":{"Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acute-heart-failure-cardiogenic-shock\/","url":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acute-heart-failure-cardiogenic-shock\/","name":"Acute heart failure, cardiogenic shock &#8211; Meddists","isPartOf":{"@id":"https:\/\/meddists.com\/learn\/#website"},"datePublished":"2021-12-28T15:54:54+00:00","dateModified":"2021-12-29T22:23:38+00:00","breadcrumb":{"@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acute-heart-failure-cardiogenic-shock\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acute-heart-failure-cardiogenic-shock\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/acute-heart-failure-cardiogenic-shock\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"http:\/\/meddists.com\/learn\/"},{"@type":"ListItem","position":2,"name":"Clinical","item":"https:\/\/meddists.com\/learn\/clinical\/"},{"@type":"ListItem","position":3,"name":"Internal medicine","item":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/"},{"@type":"ListItem","position":4,"name":"Cardiology","item":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/"},{"@type":"ListItem","position":5,"name":"Acute heart failure, cardiogenic shock"}]},{"@type":"WebSite","@id":"https:\/\/meddists.com\/learn\/#website","url":"https:\/\/meddists.com\/learn\/","name":"Meddists","description":"Let&#039;s Get Studying","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/meddists.com\/learn\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/9622","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/comments?post=9622"}],"version-history":[{"count":8,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/9622\/revisions"}],"predecessor-version":[{"id":9700,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/9622\/revisions\/9700"}],"up":[{"embeddable":true,"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/pages\/410"}],"wp:attachment":[{"href":"https:\/\/meddists.com\/learn\/wp-json\/wp\/v2\/media?parent=9622"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}