Cardiogenic Shock
Overview
Cardiogenic shock occurs when your heart suddenly can't pump enough blood to your body, creating an oxygen-deficient state. The condition is most often triggered by a severe heart attack. But it can also develop because of a viral infection, an abnormal heart rhythm, a blood clot blocking an artery in the lungs, or progression of preexisting congestive heart failure.
Cardiogenic shock can be fatal if not treated immediately. But even in severe cases, about half the people who develop cardiogenic shock can survive if treated promptly with modern therapies. Once a patient is stabilized, doctors may recommend medications, surgery or other methods to treat the condition that led to cardiogenic shock.
UCSF is an international leader in cardiac care, offering conventional as well as experimental state-of-the-art therapies for all types and stages of heart disease. With a team that includes experts in general cardiology, interventional cardiology, heart failure, heart transplant surgery and other related specialties, we're able to provide the rapid, comprehensive treatment that patients in cardiogenic shock need.
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Signs & symptoms
People in cardiogenic shock may experience:
- Rapid breathing
- Severe shortness of breath
- Sudden, rapid heartbeat (tachycardia)
- Loss of consciousness
- Weak pulse
- Low blood pressure (hypotension)
- Sweating
- Pale skin
- Cold hands or feet
- Less than normal urination or none at all
Because cardiogenic shock usually results from a severe heart attack, people may also experience heart attack symptoms. These include:
- Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
- Pain extending to your shoulder, one or both arms, back, or even to your teeth and jaw
- Increasing episodes of chest pain
- Shortness of breath
- Sweating
- Light-headedness or sudden dizziness
- Nausea and vomiting
Diagnosis
Often the diagnosis of cardiogenic shock is made by the emergency medical team in the ambulance or at the hospital. These are some of the tests they may use to determine whether you had a heart attack and whether you have cardiogenic shock:
- Blood pressure measurements – Cardiogenic shock usually causes low blood pressure.
- Chest X-ray – The images provide information about your heart and blood vessels, and can reveal whether there is fluid in your lungs.
- Electrocardiogram (EKG) – This test measures your heart's electrical activity.
- Echocardiogram – This ultrasound of the heart can show blockages in the arteries and how the blood is flowing.
- Blood tests – Various analyses can reveal whether the blood has too much carbon dioxide or too little oxygen (both signs of cardiogenic shock) and can check levels of tropinin, proteins that are released when heart muscle is damaged (as occurs during a heart attack).
- Cardiac catherization – This technique can be used to look for blocked areas in your arteries and to check the amount and pressure of blood that your heart is pumping with each beat.
Treatments
The goal of cardiogenic shock treatment is to quickly restore blood pressure and heart function. This often requires a series of immediate treatments that are given in an ambulance or the emergency room. Other treatments may include medications or temporary support devices to restore blood flow as well as longer-term therapies to address the underlying condition that caused the heart to stop pumping enough blood.
Emergency and short-term treatments
Emergency treatments may include delivering enriched oxygen via a tube or mask; breathing assistance, using a ventilator; and intravenous (IV) fluids and medications to support blood pressure or heart function.
Depending on the cause of cardiogenic shock, an array of drugs may be used as part of treatment. These include:
- Clot-busting drugs, such as tissue plasminogen activator (tPA) to dissolve coronary artery clots
- Anticlotting medicines – such as aspirin, clopidogrel or heparin – to prevent new clots
- Drugs to increase the heart's pumping ability, such as dobutamine, dopamine and norepinephrine
- Nitroglycerin to relax and widen blood vessels
- Drugs that decrease the heart's workload and pain, relieve anxiety or regulate heart rhythm
If medications don't stabilize your condition, your doctor may advise use of a support device that can temporarily take over the job of pumping your blood, restoring proper blood flow and giving your heart time to recover. These devices don't require invasive surgery. Options include:
- Intra-aortic balloon pump – A tiny balloon is placed in the aortic artery (the heart's main artery) via a thin, flexible tube called a catheter; the balloon inflates and deflates to move blood coming from your heart.
- Impella heart pump – Delivered via a catheter threaded through an artery, this small pump is implanted in the left side of the heart. It draws oxygenated blood from the heart and pushes it out to the body.
- Extracorporeal membrane oxygenation (ECMO) – An external device is used to pump and oxygenate your blood, allowing your heart and lungs to rest.
Longer-term treatments
Once doctors have determined the cause of a patient's cardiogenic shock, they may recommend various procedures or devices to address the underlying problem.
For a coronary artery blockage, treatments include:
- Coronary bypass surgery – a procedure to create a new route that allows blood to flow around a narrowed or blocked artery
- Percutaneous coronary interventions – minimally invasive procedures that use catheters to open a blocked artery and restore blood flow
For an abnormal heart rhythm, treatments include:
- Cardioversion – Medication or a brief electric shock resets the heart and restores a normal heartbeat.
- Pacemaker – This small electrical device regulates heartbeats; it's implanted under the skin and connected by wires to your heart.
- Catheter ablation – This minimally invasive procedure disrupts the electrical pathways causing the heart to beat too fast or irregularly.
If the cause of cardiogenic shock is a heart defect or advanced heart failure, more extensive treatment may be needed. Possibilities include surgery to repair or replace a faulty valve, mechanical circulatory support (devices that assist the heart's pumping action) or heart transplantation.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
