Intra-Aortic Balloon Pump Review 9/06

Deflation: treating cardiogenic shock

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Deflation: treating cardiogenic shock:

    1. What is cardiogenic shock?

“Cardiogenic” means that the shock state is being caused by heart failure: the pump isn’t pumping. Why not?

This is actually a pretty good image – the yellow bit representing infarcted area is in just the right area for producing cardiogenic shock. Why?
Remember that there are three parts of a blood pressure, and the common kinds of shock are caused by bad things happening to one of those: pump, volume, and arterial squeeze. Which one is this?

    1. What is afterload?

Afterload is the resistance that the heart is looking at, as it tries to pump blood out into the entire arterial system.

(Preload is the volume arriving in the LV, measured as the wedge pressure. What number would tell you the preload of the RV?)
Remember that the arterial bed as a whole can squeeze, and loosen. If the arterial squeeze is high, then the heart has a harder time pushing blood into the tight vessels – so looser is better! Not too loose! Afterload corresponds to the SVR number – normal is around 1000, septic would be low, and cardiogenic would be high. Remember – high is tight, low is loose.
SVR rises in cardiogenic shock, the arteries tighten, trying to keep blood pressure up… is this a good thing?

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