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Shock and
Pulmonary
Edema
Marysol I. Dalisay, MD
Cardiogenic
Shock
Cardiogenic Shock
• Systemic hypoperfusion
– Severe depression of the cardiac index {<2.2
(L/min)/m2}
– Sustained systolic arterial hypotension (<90
mmHg)
– Despite a elevating filling pressure {pulmonary
capillary wedge pressure (PCWP) <18mmHg}
– Associated with in-hospital mortality rates
>50%
Cardiogenic Shock
• Circulatory Failure:
– Caused by primary myocardial failure
• Secondary to
– Acute MI – most common
– Cardiomyopathy
– Myocarditis
– Cardiac tamponade
Incidence
• Leading cause of death of patients
hospitalized with MI
• Shock associated with ST elevation MI and
less common with non-ST elevation MI
• Complicating CS
– LV Failure - 80% of the cases
– MR, VSR, RV failure, free wall rupture,
tamponade - others
Pathophysiology
MI
Myocardial Dysfunction
Systolic Diastolic