Cardiogenic shock
Shock - cardiogenicCardiogenic shock takes place when the heart is unable to supply enough blood and oxygen to the organs of the body.
Causes
The most common causes of cardiogenic shock are serious heart conditions. Many of these occur during or after a heart attack (myocardial infarction). These complications include:
Heart attack
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...
Read Article Now Book Mark Article- A large section of heart muscle that no longer moves well or does not move at all
- Breaking open (rupture) of the heart muscle due to damage from the heart attack
- Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia
Ventricular tachycardia
Ventricular tachycardia (VT) is a rapid heartbeat that starts in the lower chambers of the heart (ventricles).
Read Article Now Book Mark ArticleVentricular fibrillation
Ventricular fibrillation (VF) is a severely abnormal heart rhythm (arrhythmia) that is life threatening.
Read Article Now Book Mark ArticleSupraventricular tachycardia
Paroxysmal supraventricular tachycardia (PSVT) is episodes of a rapid heart rate that start in a part of the heart above the ventricles. "Paroxysmal...
Read Article Now Book Mark Article - Pressure on the heart due to a buildup of fluid around it (pericardial tamponade)
- Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve
- Tear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers)
- Very slow heart rhythm (bradycardia) or problem with the electrical system of the heart (heart block)
Cardiogenic shock occurs when the heart is unable to supply as much blood as the body needs. It can happen even if there hasn't been a heart attack. For example, if one of these problems listed above occurs and your heart function drops suddenly. Or if a valve becomes obstructed or if a combination of problems occurs.
Symptoms
Symptoms include:
- Chest pain or pressure
- Coma
- Decreased urination
- Fast breathing
Fast breathing
Hyperventilation is rapid and deep breathing. It is also called overbreathing, and it may leave you feeling breathless.
Read Article Now Book Mark Article - Fast pulse
- Heavy sweating, moist skin
Heavy sweating
Sweating is the release of liquid from the body's sweat glands. This liquid contains salt. This process is also called perspiration. Sweating helps...
Read Article Now Book Mark Article - Lightheadedness
- Loss of alertness and ability to concentrate
-
Restlessness, agitation, confusion
Agitation
Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.
Read Article Now Book Mark ArticleConfusion
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
Read Article Now Book Mark Article - Shortness of breath
- Skin that feels cool to the touch
- Pale skin color or blotchy skin
- Weak (thready) pulse
Exams and Tests
An exam will show:
- Low blood pressure (most often less than 90 mmHg systolic [the first number])
- Blood pressure that drops more than 10 points when you stand up after lying down (orthostatic hypotension)
- Weak (thready) pulse
- Cold and clammy skin
To diagnose cardiogenic shock, a catheter (tube) may be placed in the lung artery (right heart catheterization). Tests may show that blood is backing up into the lungs and the heart is not pumping well.
Right heart catheterization
Swan-Ganz catheterization (also called right heart catheterization or pulmonary artery catheterization) is the passing of a thin tube (catheter) into...
Read Article Now Book Mark ArticleTests include:
- Cardiac catheterization
Cardiac catheterization
Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart. The catheter is most often insert...
Read Article Now Book Mark Article - Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
Read Article Now Book Mark Article - Coronary angiography
Coronary angiography
Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart....
Read Article Now Book Mark Article - Echocardiogram
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
Read Article Now Book Mark Article - Electrocardiogram
Electrocardiogram
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
Read Article Now Book Mark Article - Nuclear scan of the heart
Other tests may be done to find out why the heart is not working properly.
Lab tests include:
- Arterial blood gas
Arterial blood gas
Blood gases are a measurement of how much oxygen and carbon dioxide are in your blood. They also determine the acidity (pH) of your blood.
Read Article Now Book Mark Article - Blood chemistry (chem-7, chem-20, electrolytes, lactic acid level)
Blood chemistry
A comprehensive metabolic panel is a group of blood tests. They provide an overall picture of your body's chemical balance and metabolism. Metaboli...
Read Article Now Book Mark ArticleChem-7
The basic metabolic panel is a group of blood tests that provides information about your body's metabolism.
Read Article Now Book Mark ArticleChem-20
A comprehensive metabolic panel is a group of blood tests. They provide an overall picture of your body's chemical balance and metabolism. Metaboli...
Read Article Now Book Mark ArticleElectrolytes
Electrolytes are minerals in your blood and other body fluids that carry an electric charge. Electrolytes affect how your body functions in many ways...
Read Article Now Book Mark Article - Cardiac enzymes (troponin, CKMB)
- Complete blood count (CBC)
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
Read Article Now Book Mark Article - Thyroid stimulating hormone (TSH)
Treatment
Cardiogenic shock is a medical emergency. You will need to stay in the hospital, most often in the Intensive or Coronary Care Unit (ICU). The goal of treatment is to find and treat the cause of shock to save your life.
You may need medicines to increase blood pressure and improve heart function, including:
- Dobutamine
- Dopamine
- Epinephrine
- Levosimendan
- Milrinone
- Norepinephrine
- Vasopressin
These medicines may help in the short-term. They are not often used for a long time.
When a heart rhythm disturbance (dysrhythmia) is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include:
- Electrical "shock" therapy (defibrillation or cardioversion)
- Implanting a temporary pacemaker
- Medicines given through a vein (IV)
You may also receive:
- Pain medicine
- Oxygen
- Fluids, blood, and blood products through a vein (IV)
Other treatments for shock may include:
- Cardiac catheterization with coronary angioplasty and stenting
Cardiac catheterization
Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart. The catheter is most often insert...
Read Article Now Book Mark ArticleCoronary angioplasty and stenting
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary art...
Read Article Now Book Mark Article - Heart monitoring to guide treatment
- Heart surgery (coronary artery bypass surgery, heart valve replacement, left ventricular assist device)
Coronary artery bypass surgery
Heart bypass surgery creates a new route, called a bypass, for blood and oxygen to go around a blockage to reach your heart.
Read Article Now Book Mark ArticleHeart valve replacement
Heart valve surgery is used to repair or replace diseased heart valves. Blood that flows between different chambers of your heart must flow through a...
Read Article Now Book Mark ArticleVentricular assist device
Ventricular assist devices (VADs) help your heart pump blood from one of the main pumping chambers to the rest of your body or to the other side of t...
Read Article Now Book Mark Article - Intra-aortic balloon counterpulsation (IABP) to help the heart work better
- Pacemaker
Pacemaker
A pacemaker is a small, battery-operated device. This device senses when your heart is beating too slowly. It sends a signal to your heart that mak...
Read Article Now Book Mark Article - Ventricular assist device or other mechanical support
Outlook (Prognosis)
In the past, the death rate from cardiogenic shock ranged from 80% to 90%. In more recent studies, this rate has decreased to 50% to 75%.
When cardiogenic shock is not treated, the outlook is very poor.
Possible Complications
Complications may include:
- Brain damage
- Kidney damage
Kidney damage
Acute kidney failure is the rapid (less than 2 days) loss of your kidneys' ability to remove waste and help balance fluids and electrolytes in your b...
Read Article Now Book Mark Article - Liver damage
When to Contact a Medical Professional
Go to the emergency room or call 911 or the local emergency number if you have symptoms of cardiogenic shock. Cardiogenic shock is a medical emergency.
Prevention
You may reduce the risk for developing cardiogenic shock by:
- Quickly treating its cause (such as heart attack or heart valve problem)
- Preventing and treating the risk factors for heart disease, such as diabetes, high blood pressure, high cholesterol and triglycerides, or tobacco use
References
Felker GM, Teerlink JR. Diagnosis and management of acute heart failure. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 49.
McMurray JJV, Pfeffer MA. Heart failure: treatment and prognosis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024: chap 46.
Rogers JG, O'Connor CM. Heart failure: epidemiology, pathobiology, and diagnosis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024: chap 45.
Heart - section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart - section through the middle
illustration
Review Date: 5/27/2024
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.