Definitions and Treatment -

Cardiogenic and Septic Shock

Cardiogenic Shock Septic Shock
Systolic blood pressure: Signs of impaired organ Optional haemodynamic Criteria: Organ Criteria: Risk of
<90mmHg for 30 perfusion: criteria:
minutes despite a) Altered mental status a) Elevated LV-filling pressures
Dysfunction Infection
adequate volume b) Cold, clammy skin PWP: ≥ 15 mmHg
status c) Oliguria: <0.5ml/h for b) R educed cardiac index: Mental status
or 6h ≤ 1.8 L/min/m2 without respiratory rate Clinic, Laboratory,
Vasopressors required d) Increased serum support ≥22/min systolic blood Temperature, Leukocytes,
to achieve/maintain lactate >2mmol/L ≤ 2.2 L/min/m2 with support pressure <100mmHg Heart Rate,
≥90mmHg “qSOFA= quick “Biomarker“,
SOFA“ Antibiotics

Right ventricular failure Left ventricular failure AND

Suspicion SEPSIS
Criteria Criteria

ΔSOFA ≥2
sequential organ failure assessment
Acute Myocardial Ischaemia (80% of cardiogenic shock) PaO2/FiO2, platelets, bilirubin, mean arterial
pressure (MAP), catecholamines,
Myocardial ischaemia associated with characteristic ischaemic
GCS (Glasgow Coma Scale),
electrocardiographic abnormalities and/or serum troponin elevation,
creatinine, urine output
with a diagnosis of a type 1 myocardial infarction

Pulmonary Embolism Acute Cardiomyopathy

Typical signs with dyspnoea, chest No history of prior heart failure Diagnosis SEPSIS
pain, (pre) syncope, haemoptysis secondary to a primary myocardial
Simplified version of the Wells rule process (myocarditis, tachycardia-
or revised Geneva score induced cardiomyopathy, toxic Volume AND
D-Dimer testing cardiomyopathy (e.g., alcohol, vasopressor for MAP >65mmHg
chemotherapy), peripartum AND
cardiomyopathy, Tako-Tsubo serum lactate >2mmol/L
Pulmonary Arterial Hypertension cardiomyopathy or idiopathic
(pre-capillary) cardiomyopathy
Mean PAPm ≥25mmHg and
PWP ≤15mmHg
Chronic Cardiomyopathy Diagnosis SEPTIC SHOCK
Low central venous O2 saturation
Decompensation of a previously
(<60%)
known cardiomyopathy of any origin

Action
Cardiac tamponade
Post Cardiac Surgery
Tachycardia, dyspnoea, muffled
No weaning from cardiopulmonary
heart sounds, distended neck veins,
bypass possible or development
pulsus paradoxus
of cardiogenic shock after cardiac Volume management
Causes: Trauma, iatrogenic, cancer, Blood cultures Source control
surgery (including post-heart Volume should be infused
pericarditis, tuberculosis, aortic 2 samples of Control of apparent
transplantation) as long as haemodynamic
dissection aerobe/anaerobe foci in the first
parameters improve.
cultures before 12 hours after
30ml/kg in the first 3h
antibiotic therapy diagnosis
CVP 8-12mmHg
Action
Mechanical ventilation
Vaspopressor Blood products Target tidal volume of 6ml/kg
Norepinephrine is Transfusion only predicted body weight
Acute Myocardial recommended if hemoglobin is Upper limit goal of plateau
Infarction Pulmonary embolism MAP >65mmHg below 7.0 g/dL pressures of 30cm H2O
Coronary angiography – Computer Careful Volume
Early revascularization Tomography /and or and/or red
Echocardiography echocardiography – packed cells Antibiotics
– Mechanical lysis or surgery Administration of intra venous antimicrobials as soon as possible after
complications recognition and within 1 h for both sepsis and septic shock

Acute or chronic cardiomyopathy/

Abbreviations:
Cardiac tamponade Post cardiac surgery
mL= milliliter
Pericardiocentesis Fluid challenge if no overt volume overload, L= liter
Echocardiography inotropes (Dobutamine, Levosimendan) and /or h= hour
Surgery (aortic vasopressors (Norepinephrine); LV= left ventricle
PWP= pulmonary wedge pressure
dissection) consider temporary mechanical circulatory assist PAPM= mean pulmonary arterial pressure
devices in hemodynamic shock MAP= mean arterial pressure
mmHg= Milimeters mercury

Reference for septic shock:

Singer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315:801-10.