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|SubCategory=Cardiology
|SubCategory=Cardiology
|Prompt=An 82-year-old man is brought to the emergency department with severe shortness of breath, sweating, and altered state of consciousness. Past medical history is significant for prior myocardial infarction with ischemic heart failure. Physical exam reveals cold extremities. After initial assessment, the patient is diagnosed with cardiogenic shock. Which of the following additional findings is consistent with the patient's condition?
|Prompt=An 82-year-old man is brought to the emergency department with severe shortness of breath, sweating, and altered state of consciousness. Past medical history is significant for prior myocardial infarction with ischemic heart failure. Physical exam reveals cold extremities. After initial assessment, the patient is diagnosed with cardiogenic shock. Which of the following additional findings is consistent with the patient's condition?
|Explanation=The patient in this scenario is presenting with cardiogenic shock most likely due to a low-output heart failure. The patient has symptoms and a past medical history consistent with this diagnosis. Cardiogenic shock is characterized by increased total peripheral resistance, which explains the patient's cold extremities. Additionally, patients often has very weak and sometimes absent radial pulses due to the combination of low-output circulation and tachyarrhythmias. Given the decreased renal perfusion, patients with cardiogenic shock often have oliguria or  anuria secondary to acute kidney injury. Although considered a state of shock, it is always important to note that cardiogenic shock is associated with tachycardia and tachyarrhythmias, not bradycardia, in attempt to compensate for the low-output.
|Explanation=The patient in this scenario is presenting with [[cardiogenic shock]] most likely due to a low-output heart failure. The patient has symptoms and a past medical history consistent with this diagnosis. [[Cardiogenic shock]] is characterized by increased total peripheral resistance, which explains the patient's cold extremities. Additionally, patients often has very weak and sometimes absent radial pulses due to the combination of low-output circulation and [[tachyarrhythmia]]s. Given the decreased renal perfusion, patients with cardiogenic shock often have [[oliguria]] or  [[anuria]] secondary to [[acute kidney injury]]. Although considered a state of shock, it is always important to note that cardiogenic shock is associated with tachycardia and tachyarrhythmias, not [[bradycardia]], in attempt to compensate for the low output.
|AnswerA=Decreased total peripheral resistance
|AnswerA=Decreased total peripheral resistance
|AnswerAExp=Total peripheral resistance increases in cardiogenic shock.
|AnswerAExp=Total peripheral resistance increases in cardiogenic shock.
|AnswerB=High-output failure
|AnswerB=High-output heart failure
|AnswerBExp=Cardiogenic shock is defined as low-output failure.
|AnswerBExp=Cardiogenic shock is defined as low-output failure.
|AnswerC=Tachycardia
|AnswerC=Tachycardia
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|AnswerE=Polyuria
|AnswerE=Polyuria
|AnswerEExp=Patients with cardiogenic shock often have oliguria due to decreased perfusion to the kidneys.
|AnswerEExp=Patients with cardiogenic shock often have oliguria due to decreased perfusion to the kidneys.
|EducationalObjectives=Patients with cardiogenic shock, a state of low-output failure, usually have tachycardia
|EducationalObjectives=Patients with cardiogenic shock usually have associated tachycardia to compensate for the low output.
|References=Felker GM, Adams KF, Konstam MA, O'connor CM, Gheorghiade M. The problem of decompensated heart failure: nomenclature, classification, and risk stratification. Am Heart J. 2003;145(2 Suppl):S18-25.
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=cardiogenic, shock, tachycardia, bradycardia, low, output, high, total, peripheral, resistance, heart, failure, decompensated, cardiac, output
|WBRKeyword=Cardiogenic shock, Tachycardia, Bradycardia, Low-output heart failure, High-output heart failure, Heart failure,
|Approved=No
|Approved=Yes
}}
}}

Revision as of 19:28, 14 October 2014
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathophysiology
Sub Category SubCategory::Cardiology
Prompt [[Prompt::An 82-year-old man is brought to the emergency department with severe shortness of breath, sweating, and altered state of consciousness. Past medical history is significant for prior myocardial infarction with ischemic heart failure. Physical exam reveals cold extremities. After initial assessment, the patient is diagnosed with cardiogenic shock. Which of the following additional findings is consistent with the patient's condition?]]
Answer A AnswerA::Decreased total peripheral resistance
Answer A Explanation AnswerAExp::Total peripheral resistance increases in cardiogenic shock.
Answer B AnswerB::High-output heart failure
Answer B Explanation AnswerBExp::Cardiogenic shock is defined as low-output failure.
Answer C AnswerC::Tachycardia
Answer C Explanation AnswerCExp::Patients with cardiogenic shock often have tachycardia.
Answer D AnswerD::Strong radial pulse
Answer D Explanation AnswerDExp::Patients with cardiogenic shock often have absent pulse due to tachyarrhythmias.
Answer E AnswerE::Polyuria
Answer E Explanation AnswerEExp::Patients with cardiogenic shock often have oliguria due to decreased perfusion to the kidneys.
Right Answer RightAnswer::C
Explanation [[Explanation::The patient in this scenario is presenting with cardiogenic shock most likely due to a low-output heart failure. The patient has symptoms and a past medical history consistent with this diagnosis. Cardiogenic shock is characterized by increased total peripheral resistance, which explains the patient's cold extremities. Additionally, patients often has very weak and sometimes absent radial pulses due to the combination of low-output circulation and tachyarrhythmias. Given the decreased renal perfusion, patients with cardiogenic shock often have oliguria or anuria secondary to acute kidney injury. Although considered a state of shock, it is always important to note that cardiogenic shock is associated with tachycardia and tachyarrhythmias, not bradycardia, in attempt to compensate for the low output.

Educational Objective: Patients with cardiogenic shock usually have associated tachycardia to compensate for the low output.
References: Felker GM, Adams KF, Konstam MA, O'connor CM, Gheorghiade M. The problem of decompensated heart failure: nomenclature, classification, and risk stratification. Am Heart J. 2003;145(2 Suppl):S18-25.]]

Approved Approved::Yes
Keyword WBRKeyword::Cardiogenic shock, WBRKeyword::Tachycardia, WBRKeyword::Bradycardia, WBRKeyword::Low-output heart failure, WBRKeyword::High-output heart failure, WBRKeyword::Heart failure
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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