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CATH
CATH
During catheterization patients breathing became
very laborious along with profound acidemia
(6.98/44/71)
Urgently intubated
Asystole/3rd degree AVB/hemodynamically stable
VT
TPM
PA catheter PCWP 30, PAP 60
IABP
Cardiogenic Shock
Classic Criteria for Diagnosis of Cardiogenic Shock
1. Systemic Hypotension
systolic arterial pressure < 80 mmHg
2. Persistent Hypotension
at least 30 minutes
3. Reduced Systolic Cardiac Function
Cardiac index < 1.8 x m/min
4. Tissue Hypoperfusion
Oliguria, cold extremities, confusion
5. Increased Left Ventricular Filling
Pulmonary capillary wedge pressure > 18 mmHg
Ventricular Septal Rupture Management
Echo
IABP
Inotropic Support
Surgical Timing is controversial, but usually < 48
Free Wall Rupture
P= .027
P=.11
63.1%
Mortality (%)
56.0%
50.3%
46.7%
P=0.04
80 80 P < 0.002
P < .01
60 60 65.0%
56.8%
%
40 41.4%
40 44.9%
20 20
0 0
30 Day Mortality 6 Month Mortality
P < 0.003
P < .01
80 80
75.0% 79.2%
60 60
53.1% 56.3%
%
40 40
20 20
0 0
30 Day Mortality 6 Month Mortality
P<0.0001 77%
63%
52%
% 47%
Class I
1. IABP is recommended for STEMI patients when
cardiogenic shock is not quickly reversed with
pharmacological therapy. The IABP is a
stabilizing measure for angiography and prompt
revascularization.
2. Intra-arterial monitoring is recommended for the
management of STEMI patients with cardiogenic
shock.
ACC/AHA Guidelines for Cardiogenic Shock
Class I
Class IIa