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Cardiogenic shock

Medically reviewed on Oct 28, 2017

Overview

Cardiogenic shock is a condition in which your heart suddenly can't pump enough blood to meet your body's needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock.

Cardiogenic shock is rare, but it's often fatal if not treated immediately. If treated immediately, about half the people who develop the condition survive.

Symptoms

Cardiogenic shock signs and symptoms include:

  • 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
  • Urinating less than normal or not at all

Symptoms of a heart attack

Because cardiogenic shock usually occurs in people who are having a severe heart attack, it's important to know the signs and symptoms of a heart attack. 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
  • Lightheadedness or sudden dizziness
  • Nausea and vomiting

Seek medical attention quickly when having these signs or symptoms to decrease your risk of developing cardiogenic shock.

When to see a doctor

Getting heart attack treatment quickly improves your chance of survival and minimizes damage to your heart. If you're having symptoms of a heart attack, call 911 or other emergency medical services for help. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Don't drive yourself.

Causes

In most cases, a lack of oxygen to your heart, usually from a heart attack, damages its main pumping chamber (left ventricle). Without oxygen-rich blood circulating to that area of your heart, the heart muscle can weaken and go into cardiogenic shock.

Rarely, damage to your heart's right ventricle, which sends blood to your lungs to receive oxygen, leads to cardiogenic shock.

Other possible causes of cardiogenic shock include:

  • Inflammation of the heart muscle (myocarditis)
  • Infection of the heart valves (endocarditis)
  • Weakened heart from any cause
  • Drug overdoses or poisoning with substances that can affect your heart's pumping ability

Risk factors

If you have a heart attack, your risk of developing cardiogenic shock increases if you:

  • Are older
  • Have a history of heart failure or heart attack
  • Have blockages (coronary artery disease) in several of your heart's main arteries
  • Have diabetes or high blood pressure
  • Are female

Complications

If not treated immediately, cardiogenic shock can be fatal. Another serious complication is damage to your liver, kidneys or other organs from lack of oxygen, which can be permanent.

Prevention

The best way to prevent cardiogenic shock is to make lifestyle changes to keep your heart healthy and your blood pressure in check.

  • Don't smoke and avoid secondhand smoke. Several years after quitting smoking, your risk of stroke is the same as that of a nonsmoker.
  • Maintain a healthy weight. Being overweight contributes to other risk factors for heart attack and cardiogenic shock, such as high blood pressure, cardiovascular disease and diabetes. Losing just 10 pounds (4.5 kilograms) can lower blood pressure and improve cholesterol levels.
  • Eat less cholesterol and saturated fat. Limiting these, especially saturated fat, can reduce your risk of heart disease. Avoid trans fat.
  • Limit added sugar and alcohol. This will help you avoid nutrient-poor calories and help you maintain a healthy weight.
  • Exercise regularly. Exercise can lower your blood pressure, increase your level of high-density lipoprotein (HDL) cholesterol, and improve the overall health of your blood vessels and heart. Gradually work up to 30 minutes of activity — such as walking, jogging, swimming or bicycling — on most, if not all, days of the week.

If you have a heart attack, quick action can help prevent cardiogenic shock. Seek emergency medical help if you think you're having a heart attack.

Diagnosis

Cardiogenic shock is usually diagnosed in an emergency setting. Doctors will check for signs and symptoms of shock, and will then perform tests to find the cause. Tests might include:

  • Blood pressure measurement. People in shock have very low blood pressure.
  • Electrocardiogram (ECG). This test records the electrical activity of your heart via electrodes attached to your skin. If you have damaged heart muscle, electric problems or fluid buildup around your heart, it won't conduct electrical impulses normally.
  • Chest X-ray. This allows your doctor to check the size and shape of your heart and its blood vessels and whether there's fluid in your lungs.
  • Blood tests. You'll have blood drawn to check for organ damage, infection and heart attack. Another type of blood test called arterial blood gas might be used to measure oxygen in your blood.
  • Echocardiogram. Sound waves produce an image of your heart that can help identify damage from a heart attack.
  • Cardiac catheterization (angiogram). A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's inserted through an artery, usually in your leg. The dye makes your arteries visible on X-ray, revealing areas of blockage or narrowing.

Treatment

Cardiogenic shock treatment focuses on minimizing the damage from lack of oxygen to your heart muscle and other organs.

Emergency life support

Most people who have cardiogenic shock need extra oxygen. If necessary, you'll be connected to a breathing machine (ventilator). You'll receive medications and fluid through an intravenous (IV) line in your arm.

Medications

Fluids and plasma, given through an IV, and medications to treat cardiogenic shock, work to increase your heart's pumping ability.

  • Inotropic agents. You might be given medications to improve your heart function, such as norepinephrine (Levophed) or dopamine, until other treatments start to work.
  • Aspirin. Emergency medical workers might give you aspirin immediately to reduce blood clotting and keep your blood flowing through a narrowed artery. Take an aspirin yourself while waiting for help to arrive only if your doctor has previously told you to do so for symptoms of a heart attack.
  • Thrombolytics. These drugs, also called clot busters or fibrinolytics, help dissolve a blood clot that's blocking blood flow to your heart. The sooner you receive a thrombolytic drug after a heart attack, the greater your chances of survival. You'll likely receive thrombolytics, such as alteplase (Activase) or reteplase (Retavase), only if emergency cardiac catheterization isn't available.
  • Antiplatelet medication. Emergency room doctors might give you drugs similar to aspirin to help prevent new clots from forming. These include medications, such as oral clopidogrel (Plavix), and platelet glycoprotein IIb/IIIa receptor blockers, such as abciximab (Reopro), tirofiban (Aggrastat) and eptifibatide (Integrilin), which are given through a vein (intravenously).
  • Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less likely to form clots. IV or injectable heparin usually is given during the first few days after a heart attack.

Medical procedures

Medical procedures to treat cardiogenic shock usually focus on restoring blood flow through your heart. They include:

  • Angioplasty and stenting. If a blockage is found during a cardiac catheterization, your doctor can insert a long, thin tube (catheter) equipped with a special balloon through an artery, usually in your leg, to a blocked artery in your heart. Once in position, the balloon is briefly inflated to open the blockage.

    A metal mesh stent might be inserted into the artery to keep it open over time. In most cases, you doctor will place a stent coated with a slow-releasing medication to help keep your artery open.

  • Balloon pump. Your doctor inserts a balloon pump in the main artery off of your heart (aorta). The pump inflates and deflates within the aorta, helping blood flow and taking some of the workload off your heart.
  • Mechanical circulatory support. Methods newer than the balloon pump are being used to help improve blood flow and supply oxygen to the body, such as extracorporeal membrane oxygenation (ECMO).

Surgery

If medications and medical procedures don't work to treat cardiogenic shock, your doctor might recommend surgery.

  • Coronary artery bypass surgery. This involves sewing veins or arteries in place at a site beyond a blocked coronary artery. Your doctor might suggest this procedure after your heart has had time to recover from your heart attack. Occasionally, bypass surgery is performed on an emergency basis.
  • Surgery to repair an injury to your heart. Sometimes an injury, such as a tear in one of your heart's chambers or a damaged heart valve, can cause cardiogenic shock. Surgery might correct the problem.
  • Ventricular assist device. A mechanical device can be implanted into the abdomen and attached to the heart to help it pump. This might extend and improve the lives of some people with end-stage heart failure who are waiting for new hearts or aren't able to have heart transplantation.
  • Heart transplant. If your heart is so damaged that no other treatments work, a heart transplant may be a last resort.

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