Drugs for Cardiogenic Shock
Drugs for Cardiogenic Shock: Mkterermine (Mephentine) has only a mild vasopressor effect (even though it has both inotropic and vasoconstrictor actions), and therefore, cannot be relied upon in the treatment of cardiogenic shock. Isoproterenol, another potent vasopressor agent, is also not suitable for use in cardiogenic shock (except when associated With marked bradycardia due to heart block) because while it increases cardiac contractility, it also results in marked tachycardia, and therefore, causes a disproportionately large increase in myocardial oxygen requirement.
Digitalis has no role in the treatment of cardiogenic shock, while vasodilators carry the risk of producing a further fall in blood pressure. The only manoeuvre which can help improve the haemodynamic state in cases of cardiogenic shock and which has stood the test of time is intra-aortic balloon countsation. This is, however, a highly specialized procedure, and its details are beyond the scope of this text.
(5) Correction of Associated Factors. Metabolic acidosis may complicate cardiogenic shock and should be treated with IV sodium bicarbonate in appropriate dosage. Cardiac arrhythmias
or conduction defects may have been the immediate cause of cardiogenic shock. These should be carefully analyzed and vigorously treated.
GENERAL MEASURES
All the general measures outlined under ‘Acute Myocardial Infarction’ should be continued. An adequate airway should be established and the patient kept warm by extra sheets or blankets Application of artificial external heating (e.g., by hot water bot ties) is not recommended. An IV line should be establisher immediately and 5 rcent glucose infusion started till a mon specific therapy is initiate foleyscatheter should be inserted in the urinary bladder and urinary output recorded every 1/: hour initially and later every one hour. Restlessness and agitation; if marked, should be controlled with IM injection, of pro methazine (Phenergan) or diazepam (IV route should be avoided as it may cause further fall in blood pressure
Tags: Diazepam, methazine, vasoconstrictor actions
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