<prompt> What is the cause of myocardial shock other than Myocardial Infarction?Acute severe mitral regurgitationVentricular septal ruptureIsolated right ventricular shockAll of the above  <response>: D All of the above?Cardiogenic Shock is characteristically shows systemic hypoperfusion due to:oSevere depression of the cardiac index 2.2m2oSustained systolic arterial hypotension 90mmHgoElevated filling pressure pulmonary capillary wedge pressure 18mmHgoAssociated with in-hospital mortality rates 50.ETIOLOGIES OF CARDIOGENIC SHOCK CARDIOGENIC PULMONARY EDEMA?Etiologies of Cardiogenic Shock or Pulmonary Edema:oAcute myocardial infarctionischemia:-LV failure-Ventricular septal rupture-Papillary musclechordal rupture - severe MR-Ventricular free wall rupture with subacute tamponade-Other conditions complicating large MIs.oHemorrhage:-Infection-Excess negative inotropic or vasodilator medications.-Prior valvular heart disease-HyperglycemiaketoacidosisoPost-cardiac arrestoPost-cardiotomyoRefractory sustained tachyarrhythmiasoAcute fulminant myocarditisoEnd-stage CardiomyopathyoLV apical ballooningoTakotsubos cardiomyopathyoHypertrophic cardiomyopathy with severe outflow obstruction.oAortic dissection with aortic insufficiency or tamponade.oSevere valvular heart disease:-Critical aortic or mitral stenosis-Acute severe aortic regurgitation or mitral regurgitation.oToxicmetabolic:-Beta blocker or calcium channel antagonist overdose.?Other Etiologies of Cardiogenic Shock:oRV failure due to:-Acute myocardial infarction-Acute cor - pulmonaleoRefractory sustained bradyar- rhythmiasoPericardial tamponadeoToxicmetabolic:-Severe acidosis, severe hypoxemia?Causes of Cardiogenic Shock - LV failure:oSystolic Dysfunction:-CAD: Acute MI or ischemic most common cause-Other conditions: severe myocarditis, end stage cardiomyopathy including valvular cause, myocardial contusion.-Prolonged cardiopulmonary bypass, global hypoxemia, myocardial depression beta blocker, calcium blocker, anti-arrhythmic drug, respiratory acidosis.-Metabolic derangement E.g. acidosis, hypoPO4 , Hypo Ca.-Tachycardia related cardiomyopathy.oCardiogenic Shock - Causes:oIntrinsic cardiogenic shock - Myocardial contractility is grossly impaired E.g. Myocardial infarction, myocarditis, Cardiac arrhythmiasoCardiac compressive shock - There is compression of the cardiac chambers andor great veins, E.g. Cardiac tamponade, tension pneumothorax.oCardiac Obstruction Shock - There is obstruction either in the pulmonary or systemic circulation.-Pulmonary embolism, pulmonary vascular disease.-Mechanical obstruction to aorta, systemic arteriolar constriction. 