Cardiogenic Shock vs CHF Exacerbation: Telling Them Apart Fast

Both are pump problems. The blood pressure decides your treatment path.

Shared findings

Crackles, orthopnea, JVD, peripheral edema, pink frothy sputum in severe cases, and a history of heart failure or prior MI.

The dividing line

• CHF exacerbation: normal or elevated blood pressure, work of breathing is the problem
• Cardiogenic shock: hypotension with poor perfusion, cool clammy skin, altered mentation

Treating CHF with adequate pressure

1. Sit the patient upright
2. CPAP 5–10 cm H2O — the single highest-yield intervention
3. Nitroglycerin per protocol to reduce preload and afterload
4. Continuous 12-lead monitoring for an ischemic trigger

Treating cardiogenic shock

Avoid large fluid boluses; the ventricle is already overloaded. Small 250 mL challenges only if the lungs are dry. Start norepinephrine or dopamine per protocol, keep oxygenation adequate, and transport to a center capable of catheterization.

Exam trap

A hypotensive patient with crackles is not a candidate for a 1-liter bolus. Recognizing that distinction is exactly what these questions test.