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By Richard Mayou; Michael Sharpe; Alan Carson

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Immune system. Immune system depression will leave the patient at heightened risk of serious infection. Skin. Poor tissue perfusion and pooling within the interstitial space leave the skin vulnerable to breakdown. Management of cardiogenic shock The aims of management are: • • • to improve and maintain perfusion of the vital organs; to improve the myocardial oxygen supply/ demand ratio (possibly through revascularization); to recognize failure of treatment early, to allow a dignified and pain-free death.

2000). At doses of 3–10 γg/kg per minute there is a strong beta-1 effect that increases myocardial contractility. There will also be an unpredictable rise in heart rate and myocardial oxygen demand. At doses of 10–20 γg/kg per minute there are increasing inotropic effects but also strong alpha effects resulting in vasoconstriction. Dobutamine Dobutamine at doses of 2–20 γg/kg per minute has a potent beta-1 effect producing a predominantly inotropic response. There is some beta-2 effect that will produce mild vasodilation and may therefore lower left ventricular preload.

Sinus bradycardia can also result from suppression of the SA node during myocardial ischaemia or infarction, and in the sick sinus syndrome. A more severe and prognostically more sinister cause of symptomatic bradycardia is when there is a problem with conduction of the electrical activity of the heart between the atrium and the ventricle, usually referred to as ‘heart block’. There are many forms and many causes. ‘Heart block’ can be used to describe slowing or blocking of the conduction in and around the SA node, the atrioventricular (AV) node, and the bundle branches.

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