Question

Mr. L.V. is a 68-year-old male admitted to the coronary care unit 24 hours ago with an anteroseptal myocardial infarction (MI). His past medical history includes two other MIs within the last 5 years, obesity, hypertension, hyperlipidemia, and sleep apnea. L.V. had chest pain at home for 12 hours before seeking medical treatment. Lab results note troponin I at 5.2 mcg/L.

Mr. L.V. is currently pain free with stable VS. The heart monitor shows sinus rhythm with occasional, unifocal premature ventricular contractions and a heart rate (HR) in the 90s. His blood pressure (BP) is 130/70, respiratory rate (RR) is 24 breaths/minute and O₂ saturation is 93% on O₂ via nasal cannula at 2 L/min. He has a heparin drip infusing at 1200 U/hr and IV nitroglycerin infusing at 20 mcg/min. You are assigned to care for L.V. as part of a two-patient assignment.

Question: Cardiogenic shock can result from a variety of initiating events. In addition to L.V.'s obvious myocardial infarctions, identify other potential contributing causes that you will assess in L.V.

Answer 1

Here in Mr. L.Vs case it is clear that, even though, he is on 2 litre oxygen support his oxygen saturation in blood is just 93% and his respiratory rate is also on the higher side. One of the reasons for cardiogenic shock is poor oxygen saturation in blood because it may affect performance of vital organs. In Mr L.Vs case, his oxygen saturation has to be monitored closely.

Moreover, as per the records it is clear that he already had three MI attacks. So there is a high chance for ventricular septal rupture. This is also a contributing factor for cardiogenic shock because ventricular septal rupture adversely affects the pumping capacity of ventricles.

Other than this, he is suffering from hypertension, obesity, and hyperlipidemia which may result in the formation of blood clots, they are known for hampering free blood flow to our vital organs. We could easily consider this as well a contributing factor for cardiogenic shock.