Skin Mottling as Clinical Manifestation of Cardiogenic Shock

Authors

  • Aldo Ferly Division of Intensive Care and Cardiovascular Emergency, Department of Cardiology and Vascular Medicine, Harapan Kita Hospital, Jakarta, Indonesia
  • Isman Firdaus Division of Intensive Care and Cardiovascular Emergency, Department of Cardiology and Vascular Medicine, Harapan Kita Hospital, Jakarta, Indonesia

Keywords:

Skin Mottling, Cardiogenic Shock, Peripheral Circulation Assessment

Abstract

A 59 years old male came to the emergency department with chief complain of dyspnea.  Dyspnea has worsened since 3 days before admission accompanied with dyspnea on effort, orthopnea and paroxysmal nocturnal dyspnea. In the emergency department, patient experienced cardiac arrest after defecating, leading to cardiopulmonary resuscitation for 45 minutes. Administration of vasoactive drugs were done and the patient was intubated.Post resucitaiton physical examination showed that the patient was sedated, with blood pressure of 72/40 (on dobutamine support). Peripheral circulation examination showed cold and clammy extremities, skin mottling of the lower extremity with mottling score of 2. CRT is more than 2 seconds. Blood gas analysis showed severe metabolic acidosis with blood lactate of 8.1.Angiographic examination were previously done on the patient during the previous admission with the results of three vessels disease with a chronic total occlusion in the left anterior descending artery. However, patient had refused further intervention regarding the coronary problems. Patient also has longtsanding atrial fibrillation.Patient was admitted into the intensive care unit for further management. Patient was stabilized during admisison in the intensive care with inotropes, however despite the hemodynamic stablilization the skin remain mottled-regardless. Patient had complicating factors in the form of pneumonia and sepsis. Patient had difficulty in weaning the ventilator and died because of arrythmia complication.

Author Biographies

Aldo Ferly, Division of Intensive Care and Cardiovascular Emergency, Department of Cardiology and Vascular Medicine, Harapan Kita Hospital, Jakarta, Indonesia

Resident - Division of Intensive Care and Cardiovascular Emergency, Department of Cardiology and Vascular Medicine, Harapan Kita

Isman Firdaus, Division of Intensive Care and Cardiovascular Emergency, Department of Cardiology and Vascular Medicine, Harapan Kita Hospital, Jakarta, Indonesia

Consultant - Division of Intensive Care and Cardiovascular Emergency, Department of Cardiology and Vascular Medicine, Harapan Kita

References

van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: A scientific statement from the American Heart Association. Circulation. 2017;136(16):e232–68.

Hanson ID, Tagami T, Mando R, et al. SCAI shock classification in acute myocardial infarction: Insights from the National Cardiogenic Shock Initiative. Catheter Cardiovasc Interv. 2020;96(6):1137–42.

Ait-Oufella H, Bakker J. Understanding clinical signs of poor tissue perfusion during septic shock. Intensive Care Med. 2016;42(12):2070–2.

Jouffroy R, Saade A, Tourtier JP, et al. Skin mottling score and capillary refill time to assess mortality of septic shock since pre-hospital setting. Am J Emerg Med. 2019;37(4):664–71.

Coudroy R, Jamet A, Frat JP, et al. Incidence and impact of skin mottling over the knee and its duration on outcome in critically ill patients. Intensive Care Med. 2015;41(3):452–9.

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Published

2023-01-10

How to Cite

Ferly, A., & Firdaus, I. (2023). Skin Mottling as Clinical Manifestation of Cardiogenic Shock. Acta Medica Indonesiana, 54(4), 645. Retrieved from https://actamedindones.org/index.php/ijim/article/view/2247

Issue

Section

MEDICAL ILLUSTRATION