Second Degree Atrioventricular Block-Mobitz Type II (Second Degree Heart Block-Mobitz Type II) (see Second Degree Atrioventricular Block-Mobitz Type II, [[Second Degree Atrioventricular Block-Mobitz Type II]])
Sinus Bradycardia (see Bradycardia, [[Bradycardia]])
Third Degree Atrioventricular Block (Third Degree Heart Block, Complete Heart Block) (see Third Degree Atrioventricular Block, [[Third Degree Atrioventricular Block]])
Pulseless Electrical Activity (PEA) (see Pulseless Electrical Activity, [[Pulseless Electrical Activity]]): may occur in cases of tension pneumothorax, tamponade
Treatment
Inotropes
Norepinephrine: improves myocardial oxygen metabolism (increases myocardial lactate extraction) in patients with cardiogenic shock by increasing perfusion pressure and myocardial oxygen supply
Dopamine: worsens myocardial oxygen metabolism because of the associated tachycardia
In cardiogenic shock, the use of dopamine increases mortality, as compared to norepinephrine
Intra-Aortic Balloon Pump (IABP)
Useful for cases unresponsive to medical therapy
Inflates during early diastole (pushing blood toward head and neck arteries and coronary arteries) with rapid deflation prior to systole: decreased afterload (decreased SVR)/ decreased LV-EDP/ modestly decreased aortic systolic pressure -> increased CO
In cases of MR or VSD, aortic systolic pressure usually increases modestly
Improves myocardial lactate production, arterial BP, and CO
Proven to improve survival only in MI patients with complicating ruptured ventricular septum or ruptured papillary muscle
PRBC Transfusion
No specific Hct has been documented to improve any clinical factor or outcome
However, doubling the Hct (from 20 to 40%) will double plasma viscosity, increasing O2 delivery to coronary arteries but increasing myocardial work
References
Effect of isoproterenol, norepinephrine and intraaortic counterpulsation on hemodynamics and myocardial metabolism in shock following myocardial infarction. Circulation 1972; 37:335- 351
Effect of dopamine on hemodynamics and myocardial metabolism in shock following acute myocardial infarction in man. Circulation 1978; 57:361-365
Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010; 362:779-789