**7. Cardiogenic shock**

Cardiogenic shock results when more than 40% of the myocardium is damaged by necrosis from ischemia, inflammation, and toxins. There is decreased cardiac output due to pump failure such as cardiomyopathy, myocardial infarction, valvular insufficiency, and arrhythmias. This shock can further persist and eventually lead to cardiac arrest. Usually patients in cardiogenic shock look ill, drowsy, sweaty, and pale and can have tachycardia with weak pulse and hypotensive. The urine output would be deceased to less than 0.5 ml/kg/h, and serum lactic acid would be as high as 4 mmol/L, indicating circulatory insufficiency. Left ventricular dysfunction can be detected by echo early in the course of cardiogenic shock. Patients with severe left ventricle dysfunction are more liable to develop shock than those with mild to moderate dysfunction. Serial cardiac markers and bedside echo for such cases are worth doing as they can aid in diagnosis and effective management. Patient needs to be monitored closely and vital signs recorded frequently. It is worth to have an arterial line in place for accurate blood pressure readings. Monitoring urine output, base deficit, and serum lactic acid is important for the assessment of resuscitation in all patients who are in shock [4] (**Figure 5**).

**8. Obstructive shock**

**Figure 5.** Pathophysiology of cardiogenic shock [7].

vascular resistance.

**9. Neurogenic shock**

**10. Anaphylactic shock**

restrictive cardiomyopathy [4].

thetic chain injury resulting in vasodilation.

It is usually due to extra cardiac etiologies which result in poor right ventricle output. Causes are:

Shock

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http://dx.doi.org/10.5772/intechopen.76242

• Pulmonary: right ventricular failure from pulmonary embolism or severe pulmonary hypertension, as the heart cannot generate enough pressure to overcome the high pulmonary

• Mechanical: there is a reduction in venous return to the right atrium and inadequate right ventricle filling. Causes: tension pneumothorax, tamponade, constrictive pericarditis, and

It is characterized by hypotension due to severe brainstem or spinal cord injury resulting in autonomic system disruption. Trauma to the cervical or upper thoracic spine leads to sympa-

Immunoglobulin E mediated response due to insect stings, food, and drugs. Cardinal feature is circulatory collapse associated with bronchospasm and increase airway resistance. It can be associated with skin manifestations of wheals and hyperemia. There can also be vomiting and

Good fluid resuscitation and vasopressors would help to manage this type of shock [1].

Bedside ultrasound would be of absolute benefit in diagnosing obstructive shock [2].

Management of cardiogenic shock includes:


Emergency reperfusion procedure (thrombolysis/PTCA) is not superior to medical management in cardiogenic shock, secondary to myocardial infarction. There is no reduction in the mortality rate [1].

**Figure 5.** Pathophysiology of cardiogenic shock [7].
