Cardiogenic shock chest x ray: Difference between revisions
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{{cardiogenic shock}} | {{cardiogenic shock}} | ||
{{CMG}} | {{CMG}} | ||
==Overview== | ==Overview== | ||
Attending to the catastrophic [[outcome]] of cardiogenic shock in a very short time span, its [[diagnosis]] must be reached as early as possible in order for proper [[therapy]] to be started. This period until [[diagnosis]] and [[therapy|treatment]] initiation is particularly important in the case of cardiogenic shock since the [[mortality rate]] of this condition complicating acute-[[MI]] is very high, along with the fact that the ability to revert the damage caused, through [[reperfusion]] techniques, declines considerably with [[diagnostic]] delays. Therefore and due to the unstable state of these patients, the [[diagnostic]] evaluations are usually performed as supportive measures are initiated. The [[diagnostic]] measures should start with the proper history and [[physical examination]], including [[blood pressure]] beasurements, followed by an [[EKG]], [[chest x-ray]] and collection of [[blood]] samples for evaluation. An [[ECG|electrocardiogram]] may be useful in distinguishing cardiogenic shock from other types of [[shock]], such as [[septic shock]] or [[neurogenic shock]]. A [[diagnosis]] of cardiogenic shock is suggested by the presence of [[ST segment changes]], new [[left bundle branch block]] or [[signs]] of [[cardiomyopathy]]. [[Cardiac arrhythmia]]s may also be detected on the [[EKG]]. The physician should have in mind the common features of [[shock]], irrespective of the type of [[shock]], in order to avoid delays in the [[diagnosis]]. Although not all [[shock]] patients present in the same way, these features include: abnormal [[mental status]], [[cool extremities]], [[clammy skin]], manifestations of [[hypoperfusion]], such as [[hypotension]] and [[oliguria]], as well as evidence of [[metabolic acidosis]] on the [[blood]] results.<ref>{{Cite book | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages = }}</ref> | |||
The [[chest x-ray]] will show [[pulmonary edema]], pulmonary vascular redistribution, enlarged hila, kerley's B lines, and bilateral [[pleural effusions]] in patients with [[left ventricular failure]]. In contrast, a [[pneumonia]] may be present in the patient with [[septic shock]]. | The [[chest x-ray]] will show [[pulmonary edema]], pulmonary vascular redistribution, enlarged hila, kerley's B lines, and bilateral [[pleural effusions]] in patients with [[left ventricular failure]]. In contrast, a [[pneumonia]] may be present in the patient with [[septic shock]]. | ||
Revision as of 14:07, 25 May 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Attending to the catastrophic outcome of cardiogenic shock in a very short time span, its diagnosis must be reached as early as possible in order for proper therapy to be started. This period until diagnosis and treatment initiation is particularly important in the case of cardiogenic shock since the mortality rate of this condition complicating acute-MI is very high, along with the fact that the ability to revert the damage caused, through reperfusion techniques, declines considerably with diagnostic delays. Therefore and due to the unstable state of these patients, the diagnostic evaluations are usually performed as supportive measures are initiated. The diagnostic measures should start with the proper history and physical examination, including blood pressure beasurements, followed by an EKG, chest x-ray and collection of blood samples for evaluation. An electrocardiogram may be useful in distinguishing cardiogenic shock from other types of shock, such as septic shock or neurogenic shock. A diagnosis of cardiogenic shock is suggested by the presence of ST segment changes, new left bundle branch block or signs of cardiomyopathy. Cardiac arrhythmias may also be detected on the EKG. The physician should have in mind the common features of shock, irrespective of the type of shock, in order to avoid delays in the diagnosis. Although not all shock patients present in the same way, these features include: abnormal mental status, cool extremities, clammy skin, manifestations of hypoperfusion, such as hypotension and oliguria, as well as evidence of metabolic acidosis on the blood results.[1] The chest x-ray will show pulmonary edema, pulmonary vascular redistribution, enlarged hila, kerley's B lines, and bilateral pleural effusions in patients with left ventricular failure. In contrast, a pneumonia may be present in the patient with septic shock.
Chest X-ray
- The heart may be enlarged (cardiomegaly) in the patient with tamponade. A widened mediastinum may be present in the patient with aortic dissection.
- The chest x-ray may also be useful in excluding a tension pneumothorax that may be associated with hypotension.
References
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.