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Low Cardiac Output

Cardiac Output Decreased


Presentation

  • We herein present a unique case of a difficult-to-treat Graves' disease presenting with severe pulmonary hypertension resulting in low cardiac output thyroid storm.[ncbi.nlm.nih.gov]
  • However, this clinical presentation is uncommon, and its management is controversial. We studied a cohort of 452 patients hospitalized with decompensated heart failure with an ejection fraction of 0.45.[ncbi.nlm.nih.gov]
  • We here present a patient with a history of alcoholic abuse who had suffered hemodynamic deterioration with extremely low cardiac output refractory to extracorporeal membrane oxygenation and intravenous catecholamine support, which was improved dramatically[ncbi.nlm.nih.gov]
  • The objective of the present study was to compare the effects of dobutamine and milrinone on hemodynamic parameters and oxygen supply in this population of patients.[ncbi.nlm.nih.gov]
  • In this case series we present the short-term haemodynamic effects of levosimendan added to dobutamine for the management of low cardiac output syndrome after cardiac surgery.[ncbi.nlm.nih.gov]
Falling
  • During hibernation, the tissue metabolic demands fall to 25% of the active state. Our objective was to assess cardiac function associated with metabolic depression in the hibernating vs. active states in free-ranging Scandinavian brown bears.[brage.bibsys.no]
  • Ineffective Airway Clearance Ineffective Breathing Pattern Ineffective Coping Ineffective Therapeutic Regimen Management Ineffective Tissue Perfusion Latex Allergy Response Powerlessness Rape Trauma Syndrome Risk for Aspiration Risk for Bleeding Risk for Falls[nurseslabs.com]
  • Ventricular fibrillation causes cardiac output to fall to zero, and therefore leads to profound hypotension.[cvphysiology.com]
  • Although beating faster helps to maintain cardiac output as the stroke volume falls, a faster heart rate can be counterproductive because it allows less time for the ventricle to fill with blood after each heartbeat.[northshore.org]
Heart Disease
  • Abstract: The purpose of this review is to discuss the management of the low cardiac output syndrome (LCOS) following surgery for congenital heart disease.[eurekaselect.com]
  • Therefore, it is even expectable that congenital heart disease and myocardial infarction will cause the heart to malfunction and pump less amounts of blood per minute.[ic.steadyhealth.com]
  • Abstract In 42 children with congenital heart disease coagulation factor levels were studied serially during the first 20 hours following cardiopulmonary bypass surgery.[jcp.bmj.com]
  • No References No Citations No Supplementary Data No Article Media No Metrics Keywords: Congenital heart diseases ; epoprostenol ; low cardiac output syndrome ; nitric oxide ; pediatric cardiac surgery ; pulmonary hypertension ; sildenafil Document Type[ingentaconnect.com]
Hypotension
  • A 15-year-old girl with Graves' disease presented with hypotension after methimazole and propranolol were re-started for hyperthyroidism. She was found to have pulmonary artery hypertension resulting in obstructive shock.[ncbi.nlm.nih.gov]
  • Hypotension (28%) was occasionally noted. Electrocardiograms frequently revealed right axis deviation (21%) and severe sinus arrhythmia (34%) suggesting accentuated parasympathetic nervous activity. Small heart shadow (cardiothoracic ratio[ncbi.nlm.nih.gov]
  • Secondary postoperative outcomes investigated included myocardial injury, supraventricular arrhythmias, development of LCOS, acute kidney injury (AKI), duration of mechanical ventilation, intensive care unit and hospital lengths of stay, and incidence of hypotension[ncbi.nlm.nih.gov]
  • Vasodilators are not recommended in those with a systolic BP less than 90 mmHg and a MAP less than 65 mmHg to avoid hypotension and further compromising organ perfusion.[clinicaladvisor.com]
  • Symptoms of decreased cardiac output Although the hypotension is the main symptom of this condition, it can be manifested through numerous other symptoms among which are arrhythmias, dyspnea, decreased peripheral pulses and angina as well as edema, tachypnea[ic.steadyhealth.com]
Confusion
  • Furthermore, people with decreased heart output may also experience orthopnea, weight gain, dizziness and confusion. Anxiety, weakness and tiredness are also some of the symptoms that can appear when this heart disorder is in the question.[ic.steadyhealth.com]
  • Restlessness is noted in the early stages; severe anxiety and confusion are seen in later stages. * Assess heart rate and blood pressure.[nursingcareplan.blogspot.com]
  • See Also Other nursing diagnoses available: 500 Nursing Care Plans for Free Activity Intolerance Acute Confusion Acute Pain Anxiety Caregiver Role Strain Constipation Chronic Pain Decreased Cardiac Output Deficient Fluid Volume Deficient Knowledge Diarrhea[nurseslabs.com]
  • Clinical features of the condition Fatigue, confusion, agitation and/or decreased level of consciousness Cool peripheries, mottled peripheries and delayed capillary refill time Hypotension Tachycardia or bradycardia Thready pulse Raised jugular venous[clinicaladvisor.com]
  • Classification Acute and chronic Heart failure has traditionally been described as acute or chronic but this can be confusing and should be used to describe time, rather than severity.[patient.info]
Dizziness
  • Possible cardiovascular symptoms including shortness of breath (32%), dyspnea on effort (28%), rapid heartbeat (38%), chest pain (43%), fainting (43%), orthostatic dizziness (45%) and coldness of feet (42%), were all frequent complaints.[ncbi.nlm.nih.gov]
  • Furthermore, people with decreased heart output may also experience orthopnea, weight gain, dizziness and confusion. Anxiety, weakness and tiredness are also some of the symptoms that can appear when this heart disorder is in the question.[ic.steadyhealth.com]
  • [SVO2], cardiac output) * Arrhythmias, electrocardiogram (ECG) changes * Rales, tachypnea, dyspnea, orthopnea, cough, abnormal arterial blood gases (ABGs), frothy sputum * Weight gain, edema, decreased urine output * Anxiety, restlessness * Syncope, dizziness[nursingcareplan.blogspot.com]
  • Acute decrease of blood pressure can result in the shock syndrome, whereas long-term reduction leads to lethargy, fatigue, weakness, dizziness, fainting and other symptoms.[news-medical.net]
  • The patient says he experienced an acute onset of dizziness, and “everything went black real fast.”[emsworld.com]
Altered Mental Status
  • A decline in higher cortical function may indicate diminished perfusion of the brain, which leads to an altered mental status ranging from confusion and agitation to flaccid coma. The heart plays a central role in propagating shock.[emedicine.medscape.com]
  • Hypoventilation can be caused by altered mental status such as overdose, sedation, intoxication, postictal states, head trauma, or stroke, or by a tiring CHF patient.[medicscribe.com]
  • The AHA defines patients as unstable if any of the following are present: 17 Hypotension; New-onset altered mental status; Signs of shock; Ischemic chest discomfort; Acute heart failure.[emsworld.com]

Workup

  • Clinical and echocardiographic assessment of hemodynamics was performed within 48 hours of sepsis workup and repeated at least 24 hours later.[ncbi.nlm.nih.gov]
  • (See Pathophysiology, Etiology, Presentation and Workup.) Cardiogenic shock Cardiogenic shock characterized by primary myocardial dysfunction renders the heart to be unable to maintain adequate cardiac output.[emedicine.medscape.com]
  • An echocardiogram and an electrocardiogram are standard in the workup of dyspnea that may be due to cardiac disease.[clevelandclinicmeded.com]

Treatment

  • Milrinone, epinephrine, dopamine and dobutamine are mostly used, and should be prioritised for future research on LCOS treatment.[ncbi.nlm.nih.gov]
  • Echocardiographic, Doppler-derived, time interval-based index of myocardial performance (Tei index) was used to study cardiac function prior to and while on intravenous milrinone treatment for 18-24 hours.[ncbi.nlm.nih.gov]
  • Three trials with high overall risk of bias compared levosimendan to standard treatment (enoximone or dobutamine) or placebo.[ncbi.nlm.nih.gov]
  • P-AVP positively correlated with only S-Na (r 0.454 [P 0.01]), whereas no correlation was observed with CI after VAD/HTx treatment. P-AVP 5.3 pg/ml well predicted poor 2-year survival in HF group (60% [P 0.01] vs. 90%).[ncbi.nlm.nih.gov]
  • Perioperative treatment with GIK was associated with a significant reduction in the incidence of low cardiac output state and the need for inotropic support.[ncbi.nlm.nih.gov]

Prognosis

  • Liver dysfunction due to a low cardiac output state after cardiac surgery is associated with a poor prognosis, but whether one inotrope is superior to another in improving hepatic perfusion remains uncertain.[ncbi.nlm.nih.gov]
  • Low cardiac output stimulates AVP release via a non-osmotic process that results in hyponatremia and poor prognosis in patients with stage D HF.[ncbi.nlm.nih.gov]
  • Additionally, Chagas disease patients have higher B type natriuretic peptide levels and a worse prognosis independent of lower ejection fraction.[ncbi.nlm.nih.gov]
  • Multicenter studies and late follow-up will determine whether routine use of GIK improves patient prognosis.[ncbi.nlm.nih.gov]
  • Other parameters may be more important than MELD score to predict prognosis.[gut.bmj.com]

Etiology

  • The etiology of chronic fatigue syndrome (CFS) is unknown. Orthostatic intolerance (OI) is common in CFS patients. Recently, small heart with low cardiac output has been postulated to be related to the genesis of both CFS and OI.[ncbi.nlm.nih.gov]
  • Predictors of mortality were Chagas disease (RR: 2.286, P 0.001), ischemic etiology (RR: 1.449, P 0.035), and low cardiac output (RR: 1.419, P 0.047).[ncbi.nlm.nih.gov]
  • This article provides an overview of the determinants involved in oxygen transport, the physiologic factors influencing cardiovascular function, the assessment of hemodynamic variables, the etiology of LCOS, and management strategies, including a brief[ncbi.nlm.nih.gov]
  • Depending on etiological factors, common medications include digitalis therapy, diuretics, vasodilator therapy, antidysrhythmics, ACE inhibitors, and inotropic agents. * Maintain optimal fluid balance.[nursingcareplan.blogspot.com]
  • Routine blood work can provide insight into the etiology of heart failure and extent of decompensation. A low serum sodium level often is observed with advanced heart failure and can be a poor prognostic sign.[nurseslabs.com]

Epidemiology

  • Epidemiology [ 1 , 3 ] Currently around 920,000 people in the UK have a diagnosis of heart failure. Prevalence in developed countries is approximately 1-2% of the adult population, increasing to 10% or more in those over 70 years of age.[patient.info]
  • Epidemiology The prevalence of the ‘low cardiac output state’ is difficult to define.[clinicaladvisor.com]
  • Epidemiology United States statistics The incidence rate of cardiogenic shock ranges from 5% to 10% in patients with acute MI. [8] In the Worcester Heart Attack Study, a community-wide analysis, the reported incidence rate was 7.5%. [ 9 ] The literature[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Etiology of low cardiac states by pathophysiological category Table IV.[clinicaladvisor.com]
  • Depending on the cause and pathophysiological processes involved, shock can be differentiated into hypovolaemic, obstructive, distributive or cardiogenic forms.[vetline.de]
  • Many overlapping mechanisms account for descriptive terms used in the medical literature, such as "air hunger," "chest tightness," and many others. 1 Pathophysiology The mechanisms and pathophysiology of dyspnea involve interactions between the respiratory[clevelandclinicmeded.com]
  • To understand more fully the physiology and pathophysiology of hypotension, see the Blood Pressure Regulation Tutorial .[cvphysiology.com]
  • They may also predict early in-hospital outcomes and can be useful for identifying young children at increased risk for LCOS and death after heart surgery under CPB. 9 Adrenomedullin (ADM) is reportedly associated with the pathophysiology of LCOS.[revespcardiol.org]

Prevention

  • Nursing goals, in response to hypovolemia, are to increase the circulating volume, optimize oxygen delivery, stabilize hemodynamics, improve tissue perfusion, and prevent shock.[ncbi.nlm.nih.gov]
  • Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials. Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved.[ingentaconnect.com]
  • It helps to prevent pulmonary congestion and its associated pulmonary hemorrhage.[thieme-connect.com]
  • See Arteriosclerosis - what causes it and how to prevent it . Poor conversion of fuel and oxygen into ATP ie mitochondrial failure. See CFS - The Central Cause: Mitochondrial Failure . Not enough blood in circulation. See Anaemia .[drmyhill.co.uk]
  • In our study, all the data were adjusted for the patients’ age and bodyweight to prevent these variables from influencing our results.[revespcardiol.org]

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