SELF ASSESSMENT-CARDIOGENIC SHOCK
MedEducation Flix – Cardiogenic Shock Self-Assessment
1. What is the clinical definition of cardiogenic shock?
Systolic BP <90 mmHg for ≥30 minutes or need for vasopressors with signs of end-organ hypoperfusion.
2. What are the classic clinical signs of cardiogenic shock?
Hypotension, cold extremities, oliguria, altered mental status, and elevated JVP.
3. What is the most common cause of cardiogenic shock?
Acute myocardial infarction, particularly extensive anterior STEMI.
4. What investigations are essential in suspected cardiogenic shock?
ECG, troponin, echocardiography, lactate, ABG, bedside ultrasound.
5. What blood gas finding supports tissue hypoperfusion?
Metabolic acidosis with elevated lactate.
6. What is the role of bedside echocardiography?
Assesses LV function, RV function, valve pathology, and volume status.
7. What is the SCAI classification for cardiogenic shock?
Stages A to E: At risk, Beginning, Classic, Deteriorating, Extremis.
8. Which SCAI stage requires mechanical circulatory support?
Stage D (Deteriorating) and Stage E (Extremis).
9. What is the first-line vasopressor in cardiogenic shock?
Norepinephrine.
10. When is dobutamine used in cardiogenic shock?
When there is low cardiac output and evidence of poor perfusion despite adequate filling.
11. What mechanical support is preferred in left-sided failure?
Impella or VA-ECMO depending on severity.
12. When is intra-aortic balloon pump (IABP) indicated?
Rarely used; sometimes in mechanical complications of MI or as bridge to definitive therapy.
13. What are contraindications to ECMO?
Irreversible end-organ damage, advanced age with poor functional status, or prolonged CPR without ROSC.
14. What parameters are monitored to assess response to therapy?
MAP, urine output, lactate clearance, mixed venous oxygen saturation.
15. What is the mortality rate of cardiogenic shock complicating MI?
40–50% despite aggressive treatment.
16. What lab markers suggest worse prognosis?
Elevated lactate, worsening renal function, high troponin.
17. What are the clinical signs of RV infarction?
Hypotension with clear lungs, elevated JVP; worsens with nitrates or preload reduction.
18. When is coronary angiography indicated, in a shocked patient with STEMI?
Immediately in cardiogenic shock due to suspected STEMI or NSTEMI.
19. What are the signs of a mechanical Complication of MI?
New murmur, hypotension, pulmonary edema; confirmed on echo.
20. What is the definitive treatment for VSD or papillary muscle rupture?
Emergency surgical repair.