Question !! - janaki123

[ArchivalUser]

Hi any one can plz tell me difference between CHF and cardiogenic shock

[ArchivalUser]

How do we separate hypovolemic and cardiogenic?
Pulmonary capillary wedge pressure (measures left ventricular EDV)

In Hypovolemic, what is LVEDV? Low.
In Cardiogenic, what is LVEDV? High.
In Endotoxin shock it IS decreased.

Cardio shock => elevated PCWP+ decreased CO

Hypovolemia shock=> decreased PCWP + decreased CO

B. Four kinds of shock:
1. Hypovolemic shock: blood loss, diarrhea (adult or child),loss salt lead to hypovolemic shock
2. Cardiogenic shock: MC due to MI
3. Neurogenic shock: assoc. with spinal cord injuries
4. Septic shock: MC due to E. coli; also MCC sepsis called septic shock.

5. Classical clinical presentations:

a) Hypovolemic and cardiogenic shock: you would see cold and clammy skin, b/c of vasoconstriction of the peripheral vessels by catecholamines (release is due to the decrease in SV and CO) and AG II. These will vasoconstrict the skin and redirect the blood flow to other important organs in the body like brain and kidneys, leading to a cold clammy skin. BP is decreased, pulse is increased.



c) Septic shock There is a release of endotoxins which activates the alternative complement system. The complement will eventually release C3a and C5a which are anaphylatoxins, which will stimulate the mast cells to release histamine. The histamine causes vasodilation of arterioles (the same ones of the peripheral resistance arterioles). Therefore blood flow is increased throughout the peripheral resistance arterioles and the skin feels warm. there is a HIGH output failure, with warm skin.

However, in hypovolemic and cardiogenic shock, the cardiac output is decreased (b/c the vessels are constricted by catecholamines and angiotensin II), and the skin feels cold and clammy.

C. Swan ganz catheter is inserted in the right side of the heart and it measures all parameter that is taught in physiology. All of these things are measured in a swan ganz catheter.
1. Cardiac Output: measured by swan ganz



Differences between Hypovolemic, Cardiogenic, and Septic Shock using swan ganz catheter:

CO in hypovolemic and cardiogenic? both decreased
CO in septic shock? Increased

TPR Systemic vasc resistance (TPR) is a measure of what the ARTERIOLES are doing.
TPR in hypovolemic and cardiogenic shock? Increased due to vasoconstriction
TPR in septic shock? Decreased due to vasodilation.

Mixed venous in hypovolemic and cardiogenic? Low.
Mixed venous in septic shock? High.

How do we separate hypovolemic and cardiogenic?
Pulmonary capillary wedge pressure (measures left ventricular EDV)

In Hypovolemic, what is LVEDV? Low.
In Cardiogenic, what is LVEDV? High.
In Endotoxin shock it IS decreased.


Cardio shock => elevated PCWP+ decreased CO

Hypovolemia shock=> decreased PCWP + decreased CO

[ArchivalUser]

CHF if severe, may lead lead to cardiogenic shock (exacerbation of chronic heart failure)

[ArchivalUser]

Left CHF
CHF is systolic or diastolic is made on where the dysfunction is in the timing of the heart cycle.

Presentations are usually pretty similiar in the patients besides a few S3 sound and such.

However, in Systolic HF there is poblem with the systolic portion of the cardiac cycle so there is problems with EJECTION.

It can not PUMP enough blood out. With diastolic HF there is problem with FILLING of the heart. Therefore not enough blood enters the ventricle and thus a decrease in what is pumped out.

To determine between the two is usually done by looking at the EF EJECTION FRACTION [EF]. EF is a ratio between SV/EDV. If it falls below 55% or 60%(normal is about 55% - 70%) depending on what source you look at you are looking at a problem with pumping of the blood out of the ventricle.

(Remember there is normal filling "EDV", but a smaller "SV". Therefore a smaller number divided by a bigger number would give you a smaller percent OF EF
and hence Systolic heart failure WITH LOW EF).
RX ACEI or ARB
METOPROLOL or CARVEDILOL DIURETICS
SPIRONOLACTONE
DIGOXIN

Now in diastolic there is problem with filling the heart with adequete amounts but no problem with ejecting it. So because there is a smaller EDV and there is going to be a smaller SV but they will still be relative and therefore the percentage stays normal

DIASTOLIC HF WITH NORMAL EF. Therefore if there is signs of CHF, but the Ejection Fraction is normal think DiastolicHF.


RX METOPROLOL or CARVEDILOL
& DIURETIC

[ArchivalUser]

cardiogenic shock TREATMENT??????

[ArchivalUser]

cardiogenic shock TREATMENT??????

[ArchivalUser]

In some patients following trauma, you may give boluses of saline and the pulmonary capillary wedge pressure (PCWP) may significantly elevate but the patient is still hypotensive.

This indicates left ventricular failure.Cardio shock => elevated PCWP+ decreased CO
Thus, the patient is in cardiogenic shock.

This can be due to an MI, arrhythmia, myocardial contusion, or compression (as in pericardial tamponade).

All forms of such a condition should be initially treated with intravascular volume expansion up to a PCWP of 15-20 mmHG. Inotropic meds, like dopamine or dobutamine, can then be used to maintain CO without increasing the heart rate.