Case Study Cardiogenic Shock

1. What type of shock is John exhibiting signs of? [1 mark] Give a rationale for your answer and relate this to four [4] of John’s clinical symptoms and observations. [4 marks for clinical symptoms & 4 marks for observations]
The type of shock John is exhibiting is cardiogenic shock. This type of shock occurs when the heart is unable to pump blood effectively. This is evident to patients who have had myocardial infarction, such as John’s case. In this illness, the heart has decreased contractility resulting to decreased cardiac output. Such decrease will stimulate the sympathetic nervous system to activate the compensatory mechanism by increasing the heart rate as evident in John’s vital sign to increase the peripheral pressure and ventricular

Because of this inability to contract effectively, the rest of the vital organs receive inadequate amount of blood resulting to inadequate tissue perfusion. There are two types of left-sided HF; systolic and diastolic failure. Systolic failure happens when the left ventricle doesn’t have the enough energy to pump normally the blood to the general circulation. As for diastolic failure, the left ventricle loses the ability to fill itself with blood during resting period resulting to inadequate amount of blood to be pumped out to the circulation (Weinrauch, 2008). The diastolic dysfunction will eventually lead to right-sided heart failure. Pulmonary edema or congestion happens when the left ventricle of the heart fails. This is simply because the inefficiency of its ventricle to pump effectively causes the blood to back up to the pulmonary capillaries as the pulmonary venous blood rises its pressure into the tissues and alveoli impairing the gas exchange. Pulmonary congestion will be manifested in crackles, difficulty of breathing, frothy pink-tinged sputum and shortness of breath. In addition, the decreased amount of blood ejected from the left side causes ineffective tissue perfusion. This is detrimental to other vital organs such as the kidneys. The low amount of blood delivered to the kidneys causes inadequate renal perfusion. When this happens, renin is released to secrete aldosterone, a vasoconstrictor that promotes sodium and fluid retention. Aldosterone increases the preload to increase the systolic volume (Moreau, 2006). However, this is counterproductive in the long run because an increase in the preload will wear out the heart by working double time as well as increasing lung congestion. The heart failure causes multiple organ failure in chronic conditions such as altered digestion, decreased brain perfusion