TOC | Cardiology   

SX: Diminished perfusion (BP systolic usually <90) in

A. Cardiogenic shock:      Review: Annals of Internal Medicine, 6 July 1999. 131:47-59.
1. Heart Failure (esp. LV) - acute MI is the most common cause.
a. Reduced Inotropy

b. Pressure Overload

c. Volume Overload

d. Reduced Diastolic Relaxation
      (1) Poor Compliance

      (2) Constrictive Disorder

e. Obstruction of Left Atrial Emptying
     (1) Mitral Stenosis
     (2) Left Atrial Myxoma or Thrombus

2. Arrhythmias

3. Constrictive lesions: cardiac tamponate, pericarditis, etc.

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B. Hypovolemic shock:

  1. Bleeding intravascular depletion
  2. Dehydration poor intake, N&V, diarrhea, diabetic ketoacidosis, diabetes insippidus,adrenocortical insufficiency, peritonitis, pancreatitis, burns, ascites, villous adenoma, pheochromocytoma, diuretics.

C. Distributive shock:

  1. Septic shock, or endotoxemia
  2. Neurogenic factors
  3. Anaphylaxis
  4. Metabolic factors: acute respiratory failure, acute renal failure, hepatic failure,severe acidosis or alkalosis, drug overdose.
  5. Endocrinologic disorders: adrenal insufficiency, hypothyroidism, diabetic ketoacidosis, hyperosmolar nonketotic hyperglycemic coma, hypoglycemia, diabetes insipidus, etc.
  6. Microcirculatory impairment: polycythemia vera, hyperviscosity syndrome, sickle cell anemia, fat emboli

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