Cardiogenic shock electrocardiogram: Difference between revisions
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==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 [[medical history|history]] and [[physical examination]], including [[blood pressure]] measurement, 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 | 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 [[medical history|history]] and [[physical examination]], including [[blood pressure]] measurement, 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 keep 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> | ||
==Electrocardiogram== | ==Electrocardiogram== | ||
Revision as of 14:29, 25 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 measurement, 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 keep 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]
Electrocardiogram
Knowing that the most common cause of cardiogenic shock is left ventricular failure following myocardial infarction, the EKG gains increased relevance, as it allows the physician to rapidly confirm the etiology and start proper treatment or order further diagnostic tests. Common changes include:[2]
- Q waves
- >2 mm ST elevations in multiple leads
- Left bundle branch block
- >3 mm ST depressions in multiple leads, particularly in global ischemia following severe left main coronary artery obstruction
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.