Cardiogenic Shock

Cardiogenic shock is a medical emergency that happens when your heart can’t push enough blood to your body. It can be fatal if a lack of oxygen leads to organ failure. You need treatment right away in a hospital.

Healthcare providers may categorize cardiogenic shock into a number of different stages. These range from being at risk to being very sick. Stages are:

• At risk (A): 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): No response to medicines or devices for 30 minutes and getting worse
• Extremis (E): Cardiac arrest that needs CPR, ventilator and defibrillator

An estimated 40,000 to 50,000 people per year in the United States get cardiogenic shock. This condition happens more in females. Being 75 or older and having pre-existing heart conditions raises your risk.

Symptoms of cardiogenic shock

Symptoms can include:

• Confusion or not being alert
• Fainting
• Shortness of breath
• Low pee output
• Cool hands and feet
• Loss of skin color
• Fatigue
• Swelling in your belly and legs
• Poor appetite

Get treatment right away if you have any symptoms of a heart attack.

What causes cardiogenic shock?

A heart attack is one of the most common causes of cardiogenic shock. But many heart conditions can lead to this condition. Simply put, anything that can cause your heart to work inefficiently may lead to cardiogenic shock. This includes heart attacks, abnormal heart rhythms and heart failure, for example.

Other conditions that can lead to cardiogenic shock include:

• Inflammation in your heart muscle (myocarditis)
• An infection in your heart 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 — like torn muscles supporting your valve, or a replacement valve not working right
• Damage to the wall of tissue between the left and right ventricles of your heart
• Injury to your chest

Risk factors

Several factors can increase your risk of heart disease. This can lead to cardiogenic shock at some point. 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 surgery
• Lack of physical activity

You can lower your risk by managing risk factors that you can change.

Complications of this condition

Complications from cardiogenic shock may include damage to organs like your brain, liver and kidneys. You can have abnormal heart rhythms that lead to cardiac arrest. Stroke is another possible complication. Cardiogenic shock can be fatal.

How doctors diagnose cardiogenic shock

Your healthcare provider will ask about your medical history, including how you’re feeling that day or 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

Tests that are used

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 to find blockages in the arteries that supply blood to your heart (coronary arteries). This test can also check how much blood your heart is pumping.
• Electrocardiogram (ECG/EKG) to see your heart’s electrical activity (heart rhythm)
• Echocardiogram to show the strength of your heart and any structural issues
• Chest X-ray to look for fluid in your lungs and get pictures of your heart and blood vessels
• Blood tests like lactate to check the oxygen level in your blood and look for damage to major organs

How is cardiogenic shock treated?

This is a life-threatening condition. You need emergency treatment.

The key part of cardiogenic shock treatment is improving the flow of blood and oxygen to major organs to avoid damage. Sometimes, medicines can do this. In more severe cases, you may need support devices to help your heart.

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

• Medications to help remove excess fluid, improve blood flow and support your heart function
• Oxygen (and maybe a ventilator) to help your breathing
• A Swan-Ganz catheter to monitor the pressures inside your heart
• Support devices to help your heart mechanically

Further treatment

After emergency treatment, the next step depends on the cause of your cardiogenic shock. Treatment may include:

• For a heart attack: Angioplasty and possibly a stent to help blood get through a blocked blood vessel
• For a valve problem: Heart valve repair or replacement
• For a heart with an abnormal rhythm: Defibrillation or a pacemaker
• For fluid around your heart: A procedure that uses a needle to remove excess fluid pressing on your heart
• For blocked coronary arteries: Coronary artery bypass graft (open-heart surgery) to help more blood get to your heart
• For a heart that needs extra help: ECMO (extracorporeal membrane oxygenation) to do the work of your heart and lungs, and a short-term pump in your aorta can help your heart move more blood
• For a heart that may not improve: A left ventricular assist device (LVAD), a long-term device, can support your heart (a heart transplant is the next step)

Recovery time

Your recovery time depends on the treatment you received. You may spend a week or more in the hospital. It can take several weeks to months to recover at home or in a rehab facility afterward. Going to cardiac rehab after a heart attack helps with this process.

When should I see my healthcare provider?

Call 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.

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

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

Questions to ask your provider may include:

• What do I need to be careful about in the future?
• Do I need to make changes to my daily habits?
• Which medicines do I need to keep taking and for how long?

Can this be prevented?

Getting treatment for a heart attack right away is the best way to prevent cardiogenic shock. That’s because a heart attack usually causes 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, see your provider regularly and follow your plan of care.

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 dying from cardiogenic shock goes up along with the number of organs that aren’t getting enough blood.

The chances of surviving cardiogenic shock have improved over time. But even with treatment, the condition can be fatal. Many people don’t survive.

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 conditions lead to cardiogenic shock. Infections cause septic shock. It’s possible to have both conditions at the same time.

Is cardiogenic shock a heart attack?

No, cardiogenic shock isn’t a heart attack. But a heart attack is one of the most common causes of cardiogenic shock.