Cardiogenic shock

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.

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.

Cardiogenic shock signs and symptoms include:

• Rapid breathing
• Severe shortness of breath
• Sudden, rapid heartbeat (tachycardia)
• Loss of consciousness
• Weak pulse
• 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 beyond your chest to your shoulder, arm, back, or even to your teeth and jaw
• Increasing episodes of chest pain
• Prolonged pain in the upper abdomen
• Shortness of breath
• Sweating
• Lightheadedness or sudden dizziness
• Nausea and vomiting

If you seek medical attention quickly when having these signs or symptoms, you can 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.

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

Rarely, damage to your heart’s right ventricle, which sends blood to your lungs to receive oxygen, leads to cardiogenic shock. Damage to the right ventricle hinders your heart’s ability to pump blood to your lungs, depriving your body of adequate oxygen.

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.

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

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

Kidney or liver damage can worsen cardiogenic shock because the kidneys release chemicals that keep your muscles functioning, and the liver releases proteins that help your blood clot. Organ damage can be permanent.

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 out the cause. Tests to diagnose cardiogenic shock include:

• Blood pressure measurement. People in shock often have very low blood pressure.
• Electrocardiogram (ECG). This is done to diagnose a heart attack, often while you’re answering questions about your symptoms. This test records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as “waves” displayed on a monitor or printed on paper.

  Because injured heart muscle doesn’t conduct electrical impulses normally, the ECG may show that you are having or just had a heart attack.

• 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. Blood will be drawn to check for organ damage, infection and heart attack. Another type of blood test (arterial blood gas) may be used to measure oxygen in your blood.
• Echocardiogram. Sound waves produce an image of your heart, which can help identify damage to an area of your heart from a heart attack. Sound waves directed at your heart from a wandlike device (transducer) held on your chest provide video images of your heart.
• Coronary 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, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage or narrowing.

Cardiogenic shock treatment focuses on repairing the damage to your heart muscle and other organs caused by lack of oxygen.

Emergency life support

During this treatment, which most people who have cardiogenic shock need, you’re given extra oxygen to breathe, to minimize damage to your muscles and organs. 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

Medications to treat cardiogenic shock work to improve blood flow through your heart and increase your heart’s pumping ability.

• Aspirin. Emergency medical workers may give you aspirin soon after they arrive on the scene or as soon as you get to the hospital. Aspirin reduces blood clotting and helps 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, help dissolve a blood clot that’s blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you’ll survive and lessen the damage to your heart. You’ll usually receive thrombolytics only if emergency cardiac catheterization isn’t available.
• Superaspirins. Doctors in the emergency room may give you drugs similar to aspirin to help prevent new clots from forming. These include medications, such as oral clopidogrel (Plavix) and medications called platelet glycoprotein IIb/IIIa receptor blockers, 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.
• Inotropic agents. You may be given medications, to improve and support your heart function until other treatments start to work.

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 may 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.

Surgery

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

• Coronary artery bypass surgery. This involves sewing veins or arteries in place at a site beyond a blocked coronary artery. Your doctor may 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. Your doctor may recommend surgery to correct the problem.
• Heart pumps. These mechanical devices, called ventricular assist devices, are implanted into the abdomen and attached to the heart to help it pump. Implanted heart pumps can extend and improve the lives of some people with end-stage heart failure who aren’t able to undergo heart transplantation or are waiting for a new heart.
• Heart transplant. If your heart is so damaged that no other treatments work, a heart transplant may be a last resort.

The best way to prevent cardiogenic shock is to prevent a heart attack, using the same lifestyle changes you can use to treat heart disease, including:

• Control high blood pressure (hypertension). Exercising, managing stress, maintaining a healthy weight, and limiting salt and alcohol help keep hypertension in check. Also, your doctor may prescribe medications to treat hypertension.
• Don’t 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) may lower your blood pressure and improve your cholesterol levels.
• Lower the cholesterol and saturated fat in your diet. Eating less cholesterol and fat, especially saturated fat, may reduce your risk of heart disease. If you can’t control your cholesterol through dietary changes alone, your doctor may prescribe a cholesterol-lowering medication.
• 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. It also helps you control your weight, control diabetes and reduce stress. 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 immediately if you think you’re having a heart attack.

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