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Types of cardiogenic shock in myocardial infarction (by Ganelina)1) Reflex shock — development of hypotension is associated with reflex vasodilatation. Here, myocardial contractile function does not suffer. A pain syndrome is pronounced. AP decrease is insignificant, HR is within the norm. 2) A true cardiogenic shock conditioned by an extreme degree of myocardial contractile insufficiency because of the great extent of infarction. Lethality is 80-90%. In survived patients subsequently a severe cardiac failure develops. A pain syndrome is moderately expressed. AP is sharply decreased, tachycardia > 120 beats per min. 3) Arrhythmical shock is the result of a sharp decrease of stroke volume of the heart in tachycardia or minute circulatory volume in bradycarcia. Arrhythmia is to be arrested. 4) Shock arising because of myocardial rupture (slowly proceeding rupture) has an intermittent course, congestion in the lungs and enlargement of the liver. 5) Drug shock (in application of such blockers as ornid, gangliolytics, etc.). of cardiac activity (MVC, SVH, CI) in connection with the decrease of functioning myocardial mass. A patient has a "functional aneurysm". Blood remains in the heart cavity both in the period of diastole and systole. This leads to a decrease of stroke volume (SV). An organism's response is to bring into conformity a stroke systolic output with the volume of vascular bed by means of vasomotor spasm. As a result of this TPVR increases contributing to the increase of loading on the affected myocardium which it is not able to cope with. Clinical picture of cardiogenic shock: hypotension (AP 90 mm Hg and lower) is with the signs of inadequate perfusion of peripheral tissues (cold skin integument, oliguria-anuria, CVP elevation, flaccidity, patient's consciousness inhibited) on the background of signs of acute myocardial infarction. Дата добавления: 2015-02-05 | Просмотры: 761 | Нарушение авторских прав |