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Shock (Cardiogenic Shock (Management (Intra-aortic Balloon Counter…

- - - - Flow in normal coronary:
        Regulated by microvascular resistance
        Coronary flow may be preserved at AO pressures as low as 50 mm Hg
        
        In coronary vessel with critical stenosis:
        Vasodilator reserve of microvascular bed is exhausted
        Decrease in AO pressure => Coronary hypoperfusion
  - - - Reduces afterload and augments diastolic perfusion pressure
        
        Beneficial effects occur without increase in oxygen demand
      - Indications
        
        Cardiac failure after a cardiac surgical procedure
        
        Refractory angina despite maximal medical management
        
        Cardiogenic shock, Mitral regurgitation
        
        Perioperative treatment of complications due to myocardial infarction
        
        Failed PTCA, As a bridge to cardiac transplantation
      - ContraIndications
        
        Severe aortic insufficiency
        
        Aortic aneurysm
        
        Aortic dissection
        
        Limb ischemia
        
        Thromboembolism
      - Complications
        
        Limb ischemia: Thrombosis, Emboli
        
        Bleeding and insertion site: Groin hematomas
        
        Aortic perforation and/or dissection
        
        Renal failure and bowel ischemia
        
        Neurologic complications including paraplegia
        
        Heparin induced thrombocytopenia, Infection
    - - Noradrenaline in continous i.v. flow
        
        Dopamine in continous i.v. flow
        
        Dobutamine in continous i.v. flow
        
        Adrenaline in continousi.v.flow
      - Levosimendan
        
        calcium sensitizer used during cardiogenic shock
        
        increases cardiac contractility without a rise in intracellular calcium
        
        Indications
        
        Short-term treatment of the acute heart failure
        Low cardiac output syndrome (LCOS)
        Right ventricule failure
        Cardiogenic or septic shock
         B- and Ca-blocker intoxication
        Peripartum cardiomyopathy
        Takotsubo cardiomyopathy
        
        Side effects
        
        Tachycardia, AF, VT, hypotonia, Hypokalaemia, Dizziness,
        
        headaches, Diarrhoea, constipation, vomiting