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Cardiogenic shock

Cardiogenic shock is when the heart has been damaged so much that it is unable to supply enough blood to the organs of the body.

Alternative Names

Shock - cardiogenic

Causes, incidence, and risk factors

Cardiogenic shock occurs whenever the heart is unable to pump as much blood as the body needs.

The most common causes are serious heart complications. Many of these occur during or after a heart attack (myocardial infarction). These complications include:

  • 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
  • Pressure on the heart due to a build up 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)

Symptoms

Signs and tests

An examination will show:

  • Low blood pressure (usually less than 90 systolic)
  • Blood pressure drops more than 10 points when you stand up after lying down (orthostatic hypotension)
  • Weak (thready) pulse

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 properly.

Tests include:

Other studies may be done to find out why the heart is not working properly.

Lab tests include:

Treatment

Cardiogenic shock is a medical emergency. You will need to stay in the hospital, usually in the Intensive Care Unit. 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

These medicines may help in the short-term. They are not usually 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
  • Medications given through a vein (intravenous)

You may also receive:

  • Pain medicine
  • Oxygen
  • Fluids, blood, and blood products through a vein (IV)

Other treatments for shock may include:

Expectations (prognosis)

In the past, the death rate from cardiogenic shock ranged from 80 - 90%. In more recent studies, this rate has decreased to 50 - 75%.

When cardiogenic shock is not treated, the outlook is poor.

Complications

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of cardiogenic shock. Cardiogenic shock is a medical emergency.

Prevention

You may reduce the risk of 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

Gheorghiade M, Filippatos GS, Felker GM. Diagnosis and management of acute failure syndromes. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders; 2011:chap 27.

Hollenberg S. Cardiogenic shock. In: Goldman L, Schafer AI,eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap107.

Updated: 6/22/2012

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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