4.1 I) Cardiogenic Shock

Front 1

Which is incorrect regarding Cardiogenic Shock?
1. The most common cause is massive AMI
2. Is associated with a reduced cardiac index { < 1.2 L/min/m2}

3. Is associated with an elevated capillary wedge pressure {>15mmHg}
4. Stroke Volume components = preload - afterload and contractility
5. Dobutamine is primarily a B1 adrenergic agonist

Back 1

2. Cardiac index < 2.2 L / min / m2

Front 2

In regards to cardiogenic shock and the

intra-aortic balloon pump, which is incorrect?
1. It can provide a useful BRIDGE to surgery.
2. It can be a useful supportive therapy, in conjunction with other

invasive treatments.
3. It improves coronary perfusion
4. It improves peripheral circulatory perfusion
5. It decreases the cardiac work load.

Back 2

4.

Front 3

Which is not considered a risk factor for

Cardiogenic Shock ?

1. Elderly
2. Male
3. Acute Proximal LAD occlusion
4. Multivessel disease
5. Diabetes

Back 3

2. Female > Male

Hint 3

1. Elderly
2. Female
3. Acute event +
[ impaired EF / Extensive infarct / Proximal LAD lesion occlusion / Anterior MI / multivessel disease]
4. Prior Hx
[ AMI / CCF / Diabetes ]

Front 4

5 main Group Causes of Cardiogenic Shock

Back 4

1. Acute Myocardial Infarction
2. Right ventricular infarction
3. Severe depression of Contractility
4. Mechanical Obstruction to forward blood flow
5. Regurgitation of Left ventricular output

Hint 4

1. Pump failure
[ mechanical complications - acute MR ; VSD ; Free wall rupture]
2. RV infarct
3. Contractility depression
[ Sepsis / myocarditis / cardiomyopathy / drugs-OD CCB -BB]
4. Mechanical Obstruction to flow
[ AS / HCOM / MS / Pericardial tamponade]
5. LV output regurgitation
[ chordal rupture / acute AR ]

Front 5

Causes of Cardiogenic Shock

Back 5

1. AMI

- The most common cause

- present in 6-7 % AMI

2. Other Cardiac :

- Arrhythmia

- Valvular pathology

- Cardiomyopathy

- VSD
2. Pulmonary embolus
3. Aortic dissection
4. Pericardial tamponade
5. Pericarditis - Myocarditis
6. Sepsis
7. Toxicological - Drugs { CCB / BB overdose}
8. Haemorrhage

Hint 5

1. ECG
2. Urgent Echo - CTPA
3. Urgent Echo / CT angiogram
4. Urgent Echo
5. ECG -Temperature / Hx
6. Fever / hypothermia
7. Hx
8. Bleeding / PR exam /VBG

Front 6

In regards to Cardiogenic Shock, which

statement is incorrect?
1. With RV infarction complicating inferior AMI, mortality rises

from 6% to 12%
2. The normal cardiac Index is 2.7 L/min/m2
3. Acute VSD is treated with dobutamine , nitroprusside and an IABP.
4. In the absence of a catheterisation laboratory, thrombolytic therapy will reduce mortality compared to supportive treatment alone.
5.Survival from cardiogenic shock is highest with Emergency Coronary

Intervention {Catheter laboratory / Surgery}

Back 6

1. RV infarction complicates inferior AMI

- increasing mortality from 6% to 31%

Front 7

Which is incorrect, in regards to IABP and

Cardiogenic Shock?
1. IABP decreases afterload
2. IABP lowers myocardial O2 consumption
3. IABP decreases Diastolic BP
4. IABP augments coronary perfusion
5. IABP does not improve survival without successful revascularisation / Surgical correction of an acute mechanical catastrophe.

Back 7

3. IABP increases DBP

Front 8

Indications for Angiography/PCI in

Cardiogenic Shock

Back 8

1. STEMI + Cardiogenic Shock
2. STEMI and Thrombolysis contraindications {for Institutional Transfer ASAP}
3. Cardiogenic Shock + candidates for

revascularisation {Age and premorbid Hx}
4. Cardiogenic Shock + persistent

Haemodynamic / Electrical instability.

Front 9

[ Emergency Medicine MCQ's]

Risk Groups / conditions for Cardiogenic Shock ?

Back 9

1. Older age with Anterior AMI

2. Previous AMI

3. Diabetes

4. CCF

Front 10

[ Emergency Medicine MCQ's ]

What 3 interventions offer a "bridge" to

reperfusion therapy in AMI and Cardiogenic Shock ?

Back 10

1. Vasopressors

2. Inotropes

3. Inra-aortic Balloon Pump ( IABP)

Front 11

[ Emergency Medicine MCQ's ]

Which of the following facts regarding

Cardiogenic shock is correct ?

A. The mortality is 65%

B. Intra-aortic balloon pump counter pulsation is only useful if combined with revascularisation.

C. Vasodilators are not useful in Acute mitral regurgitation.

D. Thrombolysis should not be used in cariogenic shock.

Back 11

B.

A = 80%

C = They are -decrease after load to increase

forward flow.

D = Thrombolysis can be used if timely transfer to a PCI / CABG facility not possible.