CARDIO CASE

“ KAPAG NAPAGOD ANG PUSO “

- A CASE OF CARDIOGENIC SHOCK

History:
Mrs. Corazon Pusuan is a 61 y/o female who was brought to the Emergency Room
(ER) complaining of shortness of breath, fatigue, and crushing pain beneath her
sternum radiating to her left arm and jaw. The pain lasted for 30 minutes and was not
relieved by rest .
She is a known diabetic for 15 years, hypertensive with irregular intake of maintenance
medications.
Pertinent Physical Examination
General survey: weak looking, + cold clammy perspiration, drowsy and slightly
confused
Vital signs: BP= 70/40 RR= 26/min PR= 120/ min Temp = 350 C O2 sat=
92%
HEENT: pale palpebral conjunctiva
Heart : soft S1, + S4, irregular heartbeat, no murmur
Lungs: bibasal rales, no wheezes
Lab results:
ECG : ST elevation in II,III, AVF.. Blood tests showed elevated CK-MB and troponin T
and I. 2-D ECHO showed decreased wall motion.
Thrombolysis was started. Her symptoms and vital signs improved after that.
However on the second day, she suddenly developed dyspnea, and confusion. ECG
showed ventricular fibrillation, BP dropped to 60/40 mm Hg . She was resuscitated
successfully, and was given an anti-arrhythmic drug that inactivates fast Na + channels in
the heart.. She generally improved except for occasional premature ventricular
contractions. She was sent home with advice to continue medications including her
maintenance for diabetes and hypertension.
Six months later, she again was brought to ER due to shortness of breath even on mild
exertion, 3 pillow orthopnea, pallor and weakness. She was given an inotropic agent,
but her shortness of breath persisted despite treatment. Her BP dropped to 60/ 40, her
heart rate at 46/minute, neck veins are engorged.. Patient deteriorated and expired
despite resuscitative measures.
Guide questions/ Learning Objectives:
1. Describe the effects of ischemia on the myocardial cells and on the propagation of
cardiac impulse .
2. Discuss the effects of the above conditions on the following cardiovascular
parameters
a. stroke volume d. heart rate
b. ESV and EDV e. right atrial pressure
c. Ejection fraction f. pulmonary vascular resistance
3. Explain the mechanisms that will lead to the following signs and symptoms:
a. chest pain, radiating pain
` b. irregular heart beat, ventricular fibrillation, premature ventricular contractions
c. orthopnea, dyspnea on exertion, engorged neck veins
d. hypotension, diaphoresis
4. Make a concept map starting from the pathophysiologic abnormality. Include the
physiologic processes that have been disrupted, down to the presentation of signs and
symptoms, physical and laboratory findings, leading to the final outcome of the case.