Cardiogenic shock

Overview

Cardiogenic shock is a life-threatening condition. It happens when the heart suddenly can't pump enough blood to meet the body's needs. It is most often caused by a large or severe heart attack. But not everyone who has a heart attack has cardiogenic shock.

Cardiogenic shock is rare. It's often deadly if not treated right away.

Symptoms

Cardiogenic shock symptoms include:

• Very fast breathing.
• Severe shortness of breath.
• Very fast heartbeat.
• Weak pulse.
• Low blood pressure.
• Sweating.
• Cold hands or feet.
• Urinating less than usual or not at all.
• Not being aware or alert to surroundings, also called loss of consciousness.

Symptoms of heart attack

Cardiogenic shock usually happens in people who have a severe heart attack. Symptoms of heart attack include:

• Chest pain that may feel like pressure, tightness, pain, squeezing or aching.
• Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly.
• Cold sweats.
• Fatigue.
• Heartburn, also called indigestion.
• Lightheadedness or sudden dizziness.
• Nausea.
• Shortness of breath.

A heart attack usually causes chest pain that lasts more than 15 minutes. The chest pain may be mild or severe. Some people don't have any chest pain or pressure. Symptoms may be less obvious in some people, especially for women. For example, heart attack symptoms may include nausea or a brief or sharp pain felt in the neck, arm or back.

When to see a doctor

Call 911 or your local emergency number for anyone who has symptoms of heart attack or cardiogenic shock. Getting help right away may improve the chance of survival. It also may reduce damage to the heart.

If you can't call emergency medical services, have someone drive you to the nearest hospital. Don't drive yourself.

Causes

Cardiogenic shock is usually caused by too little oxygen in the lower left heart chamber. A heart attack usually causes the low oxygen level.

Rarely, damage to the lower right heart chamber can cause cardiogenic shock.

Other possible causes of cardiogenic shock are:

• Inflammation of the heart muscle, called myocarditis.
• Infection of the inner lining of the heart's chambers and valves, also called infective endocarditis.
• Weakened heart from any cause.
• Drug overdose.

Risk factors

A heart attack increases the risk of cardiogenic shock. Your risk goes up if you:

• Are older.
• Have a history of heart failure or heart attack.
• Have heart or blood vessel disease.
• Have diabetes or high blood pressure.
• Are female.

Complications

Possible complications of cardiogenic shock are:

• Death, if the condition is not treated right away.
• Liver, kidney or other organ damage due to a lack of oxygen.

Prevention

To prevent cardiogenic shock, take steps to prevent heart attack. Try these lifestyle changes:

• Don't smoke. If you smoke, the best way to reduce your risk of heart attack and cardiogenic shock is to quit. Also stay away from secondhand smoke.
• Keep a healthy weight. Being overweight increases the risk of heart disease. Ask your healthcare team what a healthy weight is for you.
• Eat healthy. Choose plenty of fruits, vegetables and whole grains. Limit sugar, salt, and saturated and trans fats.
• Manage high blood pressure, high cholesterol and diabetes. Ask your healthcare team how often you need health checkups.
• Limit or do not drink alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
• Exercise and stay active. Exercise can lower blood pressure. It also can improve the health of the blood vessels and heart. Try to exercise at least 30 minutes every day.
• Practice good sleep habits. Poor sleep may increase the risk of heart disease and other long-term health conditions. Adults should try to get 7 to 9 hours of sleep daily.
• Manage stress. Find ways to help reduce emotional stress. Some tips are to get more exercise, practice mindfulness and connect with others in support groups.

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. A healthcare team examines you and checks for symptoms of cardiogenic shock. The team does tests to find the cause.

Tests

Tests for cardiogenic shock and its cause often include:

• Blood pressure check. Cardiogenic shock causes very low blood pressure. Blood pressure is measured in millimeters of mercury (mm Hg). In general, low blood pressure is a reading lower than 90/60 mm Hg. But a low blood pressure reading alone is not enough to diagnose cardiogenic shock.
• Electrocardiogram (ECG or EKG). This quick and simple test shows how the heart is beating. It can tell if a person is having a heart attack. Sticky patches with sensors on them go on the chest and sometimes the arms or legs. A damaged heart muscle or fluid buildup around the heart may change the pattern of the heartbeat.
• Chest X-ray. A chest X-ray shows the size and shape of the heart and lungs. It also can show if there's fluid in the lungs, which is a sign that the heart isn't pumping well.
• Blood tests. Blood tests can check for signs of organ damage, infection and heart attack. An arterial blood gas test might be done to measure oxygen in the blood.
• Echocardiogram. Sound waves create pictures of the beating heart. This test can see how blood flows through the heart and heart valves. It can tell if there's damage from a heart attack.
• Cardiac catheterization. This test looks for blocked or narrowed arteries. A doctor places a long, thin tube called a catheter through an artery, usually in the groin area or wrist. The doctor moves the tube up to the heart. Dye flows through the tube. It helps the arteries show up more clearly on images made during the test. The dye part of the test is called a coronary angiogram.

Treatment

The goal of cardiogenic shock treatment is to reduce damage to the heart muscle and other organs. Treatment often includes:

• Oxygen and emergency life support.
• Medicines to treat symptoms and prevent complications.
• Surgery or procedures to fix blood flow to the heart.

Emergency life support

Most people who have cardiogenic shock need extra oxygen. You may be connected to a breathing machine called a ventilator.

Medications

Fluids and medicines are given through a tube in a vein called an IV. Medicines are given to help the heart pump better and reduce the risk of blood clots. Medicines may include:

• Vasopressors. These medicines treat low blood pressure. They include dopamine, epinephrine (Adrenalin, Auvi-Q, others), norepinephrine (Levophed) and others.
• Inotropes. These medicines help the heart pump better. They also can help keep blood pressure stable. They may be used until other treatments start to work. Examples of these medicines are dobutamine, dopamine and milrinone.
• Aspirin. Aspirin usually is given right away if someone is having a heart attack, which can lead to cardiogenic shock. Aspirin helps reduce blood clotting. It can keep blood moving through a narrowed artery.
• Antiplatelet medicines. These medicines help prevent blood clots. They also are given if a person is having a heart attack. Examples include clopidogrel (Plavix), tirofiban (Aggrastat) and eptifibatide.
• Heparin. You may be given a medicine called heparin by IV or injection. Heparin makes the blood less sticky. It helps prevent blood clots. It's usually given during the first few days after a heart attack.

Surgery or other procedures

A surgery or other treatment may be done to fix blood flow through the heart. Surgeries and procedures for cardiogenic shock may include:

• Angioplasty and stenting. This treatment can open clogged heart arteries. It also may be called percutaneous coronary intervention. A doctor guides a thin, flexible tube called a catheter to the narrowed part of the heart artery. A tiny balloon is inflated. The balloon helps widen the blocked artery and improve blood flow. A small wire mesh tube called a stent may be placed to keep the artery open.
• Intra-aortic balloon pump. This device helps increase blood flow. It also lowers strain on the heart. A doctor places the pump in the body's main artery, called the aorta. The pump inflates and deflates within the artery.
• Extracorporeal membrane oxygenation (ECMO). An ECMO machine works like the lungs. It removes carbon dioxide and adds oxygen to the blood. During ECMO, blood is removed from the body, passed through the machine and then returned to the body.
• Coronary artery bypass grafting (CABG). This is open-heart surgery. A surgeon takes a healthy blood vessel from another part of the body to create a new path for blood in the heart. The blood then goes around the blocked or narrowed coronary artery.
• Surgery to fix an injury to the heart. Sometimes heart valve damage or a tear in a heart chamber can cause cardiogenic shock. Surgery might be done to fix the condition.
• Ventricular assist device (VAD). This device helps pump blood from the lower chambers of the heart to the rest of the body. It's a treatment for a weakened heart or heart failure. It also is called a mechanical circulatory support device. Although a VAD can be placed in one or both lower chambers of the heart, it's usually placed in the lower left one.
• Heart transplant. This treatment replaces a failing heart with a healthier heart from a donor. It may be needed if the heart is so damaged that no other treatments work.