Cardiogenic shock laboratory findings
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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 laboratory tests, these must be asked in order to confirm, sustain or rule out a clinical diagnosis that has been reached after proper history and physical examination have been taken. In the case cardiogenic shock, these may include:
Markers of Myonecrosis
An elevation of troponin and CK MB are diagnostic of myonecrosis. This would suggest either ST elevation MI, myocarditis, or myopericarditis, or myonecrosis due to profound hypophosphatemia.
Complete Blood Count
An elevated white blood cell count (WBC) may suggest an alternate diagnosis of septic shock, however, it should be noted that the WBC can be elevated in STEMI due to demarginization. A reduced hemoglobin may suggest an alternate diagnosis of hypovolemic shock. A reduced platelet count may suggest an alternate diagnosis of septic shock.
Serum Electrolytes
Hypophosphatemia should be excluded as an underlying cause. Hypophosphatemia mediated myonecrosis can be observed with the refeeding syndrome as phosphate is used to convert glucose to glycogen.
Serum Lactate
The magnitude of lactic acidosis is a maker of the extent of hypoperfusion and is 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.