MYOCARDITIS AND CARDIOGENIC SHOCK The 急性心肌炎心源性休克课件.pptVIP

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MYOCARDITIS AND CARDIOGENIC SHOCK The 急性心肌炎心源性休克课件.ppt

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MYOCARDITIS AND CARDIOGENIC SHOCK The 急性心肌炎心源性休克课件

CARDIOGENIC SHOCK Aditya Badheka, PL-1 ETIOLOGY Pump Failure Ductal dependent lesions Myocardial failure myocarditis cardiomyopathy electrolyte abnormalities ischemia Restrictive: Tamponade Abnormalities in heart rate PHYSIOLOGIC PRINCIPLES Frank-Starling Phenomenon Cardiac Output Oxygen delivery and utilization Frank-Starling Phenomenon “In the normal heart, the diastolic volume (preload) is the principal force that governs the strength of ventricular contraction.” Otto Frank and Ernest Starling CARDIOGENIC SHOCK Cardiac output is inadequate to meet tissue demands Phases: Early, compensated Late, uncompensated Hypotension and bradycardia are the signs C.O. = STROKE VOLUME X HEART RATE Stroke volume: Preload Myocardial contractility Afterload: systemic and pulmonary resistance blood viscosity Heart Rate Bradycardia Sustained tachycardia ACUTE MYOCARDITIS - DEFINITION A process characterized by inflammatory infiltrates of the myocardium, with necrosis and/or degeneration of myocytes which is very different from the ischemic damage observed in ischemic heart disease. CAUSES OF MYOCARDITIS Infectious: Viral: adenovirus (25), enterovirus, CMV, RSV Bacterial: meningococcus, TB, Legionella, Leptospira Rickettsial Protozoal: T. cruzi Non-infectious: toxic, drugs, hypersensitivity/ autoimmune Acute Viral Myocarditis Heart Failure Complete Recovery No Symptoms Chronic Dilated Cardiomyopathy Dysrhythmias/ Conduction Disorders Sudden Death Clinical Presentation of Myocarditis PATHOPHYSIOLOGY OF MYOCARDITISTHE DOMINO EFFECT Viral Infection Inflammation and Injury Decreased Myocardial Contractility Heart Enlarges: ? LVEDV ? Cardiac Output ? Sympathetic Tone CHF ? LAP Pulm. edema Scarring Dysrhythmias ISCHEMIC HEART DISEASE IN CHILDREN ALCAPA Anomalous Left Coronary Artery arising from the Pulmonary Artery Kawasaki Disease Aneurysms Other vasculitis ELECTROLYTE/METABOLIC ABNORMALITIES Hyperkalemia Hypocalcemia Hypermagnesemia Hypoxia Metabolic Acidosis VENTRICULAR FUNC