Cardiogenic shock laboratory findings: Difference between revisions
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===Complete Blood Count=== | ===Complete Blood Count=== | ||
*Elevated [[white blood cell count]] ([[WBC]]), typically with a left shift. | *Elevated [[white blood cell count]] ([[WBC]]), typically with a left shift. | ||
''It may suggest an alternate diagnosis of [[septic shock]], however, it should be noted that the [[WBC]] | ''It may suggest an alternate diagnosis of [[septic shock]], however, it should be noted that the [[WBC]] may be elevated in [[STEMI]] and [[shock]] in general, due to demargination of [[neutrophils]]. Other relevant laboratory results, such as: reduced [[hemoglobin]] may suggest an alternate [[diagnosis]] of [[hypovolemic shock]], while a reduced [[platelet count]] may suggest an alternate [[diagnosis]] of [[septic shock]]'' | ||
===Renal Function=== | ===Renal Function=== | ||
Revision as of 20:28, 24 May 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
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. 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]
Laboratory Findings
As in all laboratory tests, these must be ordered in order to confirm, sustain or rule out a clinical diagnosis that has been reached after proper history and physical examination have been made. In the case of cardiogenic shock, these may include:[2]
Arterial Blood Gas
- Hypoxemia
- Metabolic acidosis, possibly compensated by respiratory alkalosis
Cardiac Markers
- Elevated cardiac markers, such as:
- Troponin I and Troponin T
- Elevated CK MB
Complete Blood Count
- Elevated white blood cell count (WBC), typically with a left shift.
It may suggest an alternate diagnosis of septic shock, however, it should be noted that the WBC may be elevated in STEMI and shock in general, due to demargination of neutrophils. Other relevant laboratory results, such as: reduced hemoglobin may suggest an alternate diagnosis of hypovolemic shock, while a reduced platelet count may suggest an alternate diagnosis of septic shock
Renal Function
- Elevated blood urea nitrogen
- Elevated creatinine
In case of prior normal renal function, BUN and creatinine will only be elevated later on the course of the disease. If there is prior renal insufficiency, these values will be elevated earlier.
Hypophosphatemia should be excluded as an underlying cause. Myonecrosis following hypophosphatemia may be observed in refeeding syndrome, as phosphate is used to convert glucose to glycogen.
Liver Function
- Elevated hepatic transaminases, following liver hypoperfusion
Serum Lactate
- Lactic acidosis (Anion Gap Acidosis). Its magnitude, along with compensatory decrease in serum bicarbonate, are markers of the extent of hypoperfusion and valuable in gauging a patient's prognosis.
References
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.