Cardiogenic shock electrocardiogram
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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
Not all patients in cardiogenic shock present to the hospital with the condition. Some are brought primarily because of myocardial infarction and then, later during hospital stay, develop shock. To this last group the repeated EKG, alongside with an echocardiogram, gains new utility as it allows for the confirmation of recurrent ischemia, particularly in patients who have been reperfused, thereby confirming the diagnosis.
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.