Case 5 - Cardiogenic Shock 1
Indication:
i. Shock Differentiation: The patient's blood pressure was much lower than usual such that she was experiencing constant rest pain in her lower limbs -- the lack of perfusion pressure to force blood through the peripheral arterial obstructions.
The goal was to use PoCUS to elucidate the class of shock.
ii. Cardiac Evaluation: She had a known murmur, presumably due to the known mitral regurgitation. However, given it was quite a loud (grade 4) pan-systolic murmur, cardiogenic shock was considered . The LV contractility and evaluation of the mitral regurgitation were the focused upon.
Image Acquisition:
For the purposes of shock, I advocate imaging from upstream to downstream (venous to arterial) because (1) hemodynamics is complex and needs to be considered as a whole, and (2) fixing what is upstream affects what happens downstream.
i. Shock Differentiation: The patient's blood pressure was much lower than usual such that she was experiencing constant rest pain in her lower limbs -- the lack of perfusion pressure to force blood through the peripheral arterial obstructions.
The goal was to use PoCUS to elucidate the class of shock.
ii. Cardiac Evaluation: She had a known murmur, presumably due to the known mitral regurgitation. However, given it was quite a loud (grade 4) pan-systolic murmur, cardiogenic shock was considered . The LV contractility and evaluation of the mitral regurgitation were the focused upon.
Image Acquisition:
For the purposes of shock, I advocate imaging from upstream to downstream (venous to arterial) because (1) hemodynamics is complex and needs to be considered as a whole, and (2) fixing what is upstream affects what happens downstream.
Interpretation:
Moderate to severe global LV hypokinesis with significant, likely severe, MR.
Clinical Synthesis:
The cause of the shock was cardiogenic due to the LV systolic failure along with severe MR. She was, hence, commenced on dobutamine, and a cardiology consult was, hence, made.
Moderate to severe global LV hypokinesis with significant, likely severe, MR.
Clinical Synthesis:
The cause of the shock was cardiogenic due to the LV systolic failure along with severe MR. She was, hence, commenced on dobutamine, and a cardiology consult was, hence, made.