Introduction Impaired cardiac contractility and overall pump failure heart is unable to generate sufficient cardiac output to maintain tissue perfusion Myocardial failure caused by: acute MI (most common) cardiac tamponade blunt cardiac trauma air embolus tension pneumothorax arrhythmias massive PE Presentation Symptoms altered sensorium pale cool skin hypotension tachycardia pulmonary congestion Physical exam inspection JVD urine output < 20 mL/hr vascular sytolic BP < 90 Evaluation Labs cardiac enzymes Electrodiagnositcs ECG monitoring ST elevation suggests acute MI or arrhythmia as cause Studies echocardiography evaluates: valve disease ejection fraction pericardial effusions Swan-Ganz catheter PCWP pulmonary artery pressure cardiac output cardiac index SVR Differential Filling Pressure(RA and PCWP) Cardiac Output Vascular resistance Septic shock Low Increased Low Cardiogenic High Low High Hypovolemic Low Low High Cardiac tamponade High Low High Papillary muscle rupture High Low High Treatment/Management ABCs Identify and treat underlying cause acute MI valvular abnormality cardiac tamponade arrhythmia Supplemental O2 Pressors: dopamine first line dobutamine second line add norepinephrine