Cardiogenic Shock

What is cardiogenic shock?

Cardiogenic shock is a serious condition that happens when your heart can’t supply enough oxygen-rich blood to your body to meet its needs. It can be fatal when a lack of oxygen causes your organs to fail.

This condition is an emergency situation that requires immediate treatment in a hospital.

Cardiogenic shock is most often caused by a heart attack or heart failure.

What are the stages of cardiogenic shock?

Cardiogenic shock stages range from being at risk to being very ill. Stages are:

• At risk (A): Heart disease, such as heart attack or heart failure, but no signs of shock.
• Beginning (B): Low blood pressure or heart rate.
• Classic (C): Need for medicine or devices to help get blood to organs.
• Deteriorating (D): Not responding to medicine or devices and getting worse.
• Extremis (E): Cardiac arrest that needs CPR, ventilator and defibrillator.

How common is cardiogenic shock?

An estimated 40,000 to 50,000 people per year in the United States get cardiogenic shock.

Cardiogenic shock is the top cause of death in people who have a heart attack.

What are the symptoms?

It’s important to get immediate treatment if you have any symptoms of a heart attack, such as:

• Chest pain that lasts for more than a few minutes or goes away and comes back. Your chest may feel heavy, tight, full or numb. You may feel pressure, aching, burning or squeezing. The pain may feel like heartburn. In some patients, especially women, chest pain isn't always the main symptom. Be alert for other signs listed below.
• Pain or discomfort in your upper body and/or down your left arm.
• Pain in the upper abdomen, throat or jaw.
• Trouble breathing.
• Sweating or “cold sweats.”
• Fast or irregular heartbeat.
• Feeling very weak, lightheaded and/or anxious.

Other symptoms related to cardiogenic shock can include:

• Confusion or not being alert.
• Fainting.
• Very low blood pressure.
• Weak pulse.
• Trouble breathing.
• Peeing less than normal.
• Cool hands and feet.
• Pale skin.
• Feeling very tired.
• Swelling in your belly and legs.
• Poor appetite.

What causes cardiogenic shock?

A heart attack is the most common cause of cardiogenic shock. A severe heart attack can damage your heart’s main pumping chamber (left ventricle). When this happens, your body can’t get enough oxygen-rich blood.

In rare cases of cardiogenic shock, it’s the bottom right chamber of your heart (right ventricle) that’s damaged. The right ventricle pumps blood to your lungs, where it gets oxygen and then goes to the rest of your body.

Other conditions that make your heart weak and can lead to cardiogenic shock include:

• Damaged heart muscle from having a heart attack.
• Inflammation of your heart muscle (myocarditis).
• An infection of your heart’s inner lining and valves (endocarditis).
• An abnormal heart rhythm (arrhythmia).
• Too much fluid or blood around your heart (cardiac tamponade).
• A blood clot that suddenly blocks a blood vessel in your lung (pulmonary embolism).
• A heart valve problem, such as torn muscles supporting your valve or an artificial valve not working right.
• Damage to the septum that divides the left and right ventricles of your heart.
• Heart failure.
• Injury to your chest.

How is cardiogenic shock diagnosed?

Your healthcare provider will want to know your medical history, including symptoms you’re having that day or that you had recently. During a physical exam, they may find these signs of cardiogenic shock:

• A weak pulse.
• Skin that feels cold and clammy.
• Low blood pressure.
• An abnormal heart rhythm or heart murmur they can hear through a stethoscope.

What tests will be done to diagnose cardiogenic shock?

Several tests can help you find out if you have cardiogenic shock. These include:

• Blood pressure cuff: To check for low blood pressure.
• Cardiac catheterization: This procedure helps your healthcare provider find blockages in the arteries that supply blood to your heart (coronary arteries). Your provider can also use a catheterization to check the amount of blood your heart is pumping with each beat (cardiac output). A long, thin tube called a catheter is inserted in an artery through a small puncture, usually in your wrist or groin.
• Electrocardiogram (ECG/EKG): A recording of your heart’s electrical activity (heart rhythm).
• Echocardiogram: An ultrasound of your heart that allows your healthcare provider to determine the strength of your heart and look for any structural abnormalities such as problems with the valves.
• Chest X-ray: To look for fluid in your lungs and get pictures of your heart and blood vessels.
• Blood tests: To check the oxygen level in your blood and check for damage to major organs, such as your kidneys, heart and liver. They’ll also look at your electrolyte level.

How is cardiogenic shock treated?

Cardiogenic shock is a life-threatening condition and you need emergency treatment. The most important part of treatment is improving the flow of blood and oxygen to major organs to avoid damage. Sometimes, this can be achieved with medications. In more severe cases, support devices may be needed to help your heart.

Treatment that begins in a hospital emergency room or intensive care unit may include:

• Medications given through an IV to help remove excess fluid, improve blood flow, and support your heart function.
• Oxygen to help your breathing.

Placement of a temporary monitoring line called a Swan-Ganz catheter, which is a special catheter that monitors the pressures inside your heart. This can help your healthcare team to closely follow your response to treatment. Medicines may include:

• Nitroprusside.
• Norepinephrine.
• Epinephrine
• Dobutamine.
• Dopamine.
• Milrinone.
• Furosemide.
• Vasopressin.

What treatments are used for the management of cardiogenic shock?

Once you’ve received immediate emergency treatment, additional treatment depends on the cause of your cardiogenic shock.

• If you're having a heart attack: Angioplasty and possibly a stent placement to help blood get through a blood vessel with a buildup of plaque (cholesterol and fat).
• If there's a valve problem: Heart valve repair or replacement.
• If you have fluid around your heart: A procedure that uses a needle to remove excess fluid compressing your heart.
• If you have several blocked coronary arteries: Coronary artery bypass graft (open heart surgery) to help more blood get to your heart.
• If your heart remains too sick despite other treatments, you may require a machine that temporarily takes the workload from your heart and lungs (ECMO or extracorporeal membrane oxygenation). In addition to ECMO, placing a temporary pump in your aorta can help your heart pump more blood.
• If your heart function isn't expected to improve, your healthcare team may evaluate you for a left ventricular assist device (LVAD, a long-term device to support your heart) or a heart transplant.

Complications of the treatment

Many people who have a heart attack need angioplasty to open a blocked blood vessel. Complications from angioplasty are rare, but may include:

• Abnormal heart rhythm.
• Bleeding.
• Kidney injury.
• Injured blood vessel.
• Chest pain.
• Stroke.

How long does it take to recover from this treatment?

After angioplasty, people usually feel tired for a few days. But people who have angioplasty during/after a heart attack may need up to six weeks to recover from a heart attack. It’s very important to attend cardiac rehabilitation after a heart attack to help with your recovery.

How can I reduce my risk?

Several factors can increase your risk of heart disease, which can eventually lead to cardiogenic shock. Risk factors include:

• Heart failure.
• A prior heart attack.
• Coronary artery disease.
• High blood pressure.
• High cholesterol.
• Diabetes.
• Use of tobacco products.
• Overweight and obesity.
• A prior coronary artery bypass graft.
• Lack of exercise.

How can I prevent cardiogenic shock?

Because a heart attack usually causes cardiogenic shock, getting immediate treatment for a heart attack is the best way to prevent cardiogenic shock.

See your healthcare provider to find out your risk of heart disease and take steps to improve your heart health. If you have coronary artery disease, it’s important to see your provider as recommended and follow all steps in your plan of care (medications, lifestyle changes, etc.).

What can I expect if I have cardiogenic shock?

The impact cardiogenic shock has on your life depends on how quickly you get treatment. The less time you’re in shock, the better. Less time in shock means less damage to your major organs. The risk of cardiogenic shock becoming fatal goes up along with the number of organs that aren’t getting enough blood.

Complications from cardiogenic shock may include:

• Damage to organs such as your brain, liver and kidneys.
• Cardiac arrest.
• Stroke.
• Abnormal heart rhythms.
• Death.

Although the chances of surviving cardiogenic shock have improved over time, 50% to 75% of people don’t survive it. Without — and even with — treatment, the condition can be fatal.

How do I take care of myself?

Making changes to the way you live can make a difference in your heart health.

Changes you can make include:

• Exercise regularly.
• Don’t use tobacco products.
• Eat healthier foods, such as fruits, vegetables and whole grains.
• Find ways to cope with stress.

When should I see my healthcare provider?

After you have cardiogenic shock, you’ll need follow-up appointments with your healthcare provider. If you received a medical device to help your heart work better, you’ll need regular appointments to make sure your device is working right.

You should contact your healthcare provider if you start to have new symptoms.

When should I go to the ER?

Call 911 for an ambulance if you have heart attack or cardiogenic shock symptoms. Your treatment can start on the way to the hospital when you’re in an ambulance.

What questions should I ask my doctor?

• What do I need to be careful about in the future?
• Do I need cardiac rehab?
• Which medicines do I need to keep taking and for how long?

What's the difference: Cardiogenic shock vs. septic shock?

Both are forms of shock, which means your organs and tissues can’t get the oxygen they need. The causes are different for these life-threatening conditions, though. Heart attacks usually cause cardiogenic shock. Infections cause septic shock.

Is cardiogenic shock a heart attack?

No, cardiogenic shock isn’t a heart attack. However, a heart attack is the most common cause of cardiogenic shock.

What does cardiogenic shock feel like?

People with cardiogenic shock may experience:

• A feeling of panic.
• Cold, clammy skin.
• Confusion.
• Fast breathing.
• Fainting.