Cardiogenic Shock

Symptoms of cardiogenic shock

Signs and symptoms of cardiogenic shock may include:

• Rapid breathing
• Severe shortness of breath
• Sudden, rapid heartbeat (tachycardia)
• Weak pulse
• Low blood pressure (hypotension)
• Sweating
• Pale skin
• Cold hands or feet
• Less than normal urination or none at all
• Loss of consciousness

Because cardiogenic shock usually results from a severe heart attack, people may also feel the 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 to your shoulder, one or both arms, your back, or even your teeth and jaw
• Shortness of breath
• Sweating
• Light-headedness or sudden dizziness
• Nausea and vomiting

Diagnosis of cardiogenic shock

Often the diagnosis of cardiogenic shock is made by the emergency medical team in the ambulance or at the hospital. These are some of the tests they may use to determine whether you had a heart attack and if you have cardiogenic shock:

• Blood pressure measurements. Cardiogenic shock usually causes low blood pressure.
• Chest x-ray. The images provide information about your heart and blood vessels and can reveal whether there's fluid in your lungs.
• Electrocardiogram (ECG). This test measures your heart's electrical activity.
• Echocardiogram. This ultrasound of the heart can show blockages in the arteries and how your blood is flowing.
• Blood tests. Various blood tests can show whether your blood has too much carbon dioxide or too little oxygen (both signs of cardiogenic shock) and can check troponin levels, proteins that are released when the heart muscle is damaged.
• Cardiac catheterization. This procedure can be used to look for blocked areas in your arteries and to check the amount and pressure of the blood that your heart is pumping with each beat.

Treatment of cardiogenic shock

The goal of cardiogenic shock treatment is to quickly restore blood pressure and heart function. This often requires immediate treatments that are given in an ambulance or the emergency room. Other treatments may include medications or temporary support devices to restore blood flow. Longer-term therapies could address the underlying condition that caused the heart to stop pumping enough blood.

Emergency and short-term treatments of cardiogenic shock

Emergency treatments may include oxygen delivered via a tube or mask, breathing assistance using a ventilator, intravenous (IV) fluids and medications to support blood pressure or heart function.

Depending on the cause of the cardiogenic shock, different drugs may be used as part of treatment. These could include:

• Clot-busting drugs, such as tissue plasminogen activator (tPA) to dissolve coronary artery clots
• Anticlotting medicines – such as aspirin, clopidogrel or heparin – to prevent new clots
• Drugs to increase the heart's pumping ability, such as dobutamine, dopamine and norepinephrine
• Nitroglycerin to relax and widen blood vessels
• Drugs that decrease the heart's workload, relieve pain and anxiety or regulate heart rhythm

If medications don't stabilize your condition, your doctor may advise using a support device that can temporarily take over the job of pumping your blood, restoring proper blood flow and giving your heart time to recover. These devices, which don't require invasive surgery, can include:

• Intra-aortic balloon pump. A tiny balloon is placed in the aortic artery, the heart's main artery, via a thin, flexible tube called a catheter that is threaded through the blood vessels from an artery in one of the legs. The balloon inflates and deflates to move blood coming from your heart.
• Impella heart pump. Delivered via a catheter threaded through an artery, this small pump is implanted in the left side of the heart. It draws oxygenated blood from the heart and pushes it out to the body.
• Extracorporeal membrane oxygenation (ECMO). This external device is used to pump your blood and enrich the oxygen in it, allowing your heart and lungs to rest.

Treatment of underlying causes of cardiogenic shock

Once doctors have determined the cause of your cardiogenic shock, they may recommend various procedures or devices to address the underlying problem.

For a coronary artery blockage, treatments include:

• Coronary artery bypass grafting. This procedure creates a new route that allows blood to flow around a narrowed or blocked artery.
• Percutaneous coronary intervention. These are minimally invasive procedures that use catheters to open blocked arteries and restore blood flow.

For an abnormal heart rhythm, treatments include:

• Cardioversion. Medication or a brief electric shock is used to reset the heart's rhythm and restore a normal heartbeat.
• Pacemaker. This small electrical device, which regulates heartbeats, is implanted under the skin and connected by wires to your heart.
• Catheter ablation. This minimally invasive procedure disrupts the electrical pathways causing the heart to beat too fast or irregularly.

If the cause of cardiogenic shock is a heart defect or advanced heart failure, more treatment may be needed. Possibilities include surgery to repair or replace a faulty valve, mechanical circulatory support (devices that assist the heart's pumping action) or heart transplantation.