Definition of Cardiogenic shock:

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

Causes, incidence, and risk factors:

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
• Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia
• 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:

• Chest pain or pressure
• Fast breathing
• Fast pulse
• Heavy sweating, moist skin
• Restlessness, agitation, confusion
• Shortness of breath
• Skin that feels cool to the touch
• Pale skin color or blotchy skin
• Weak (thready) pulse
• Decreased mental ability
  • Loss of ability to concentrate
  • Loss of alertness
• Coma (loss of consciousness)

Signs and tests:

An examination will show:

• Low blood pressure (usually less than 90 systolic)
• Blood pressure drop of 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:

• Cardiac catheterization
• Chest x-ray
• Coronary angiography
• Echocardiogram
• Electrocardiogram
• Nuclear scans

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

Lab tests include:

• Arterial blood gas
• Blood chemistry (chem-7, chem-20, electrolytes)
• Cardiac enzymes (troponin, CKMB)
• Complete blood count (CBC)

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
• Norepinephrine

These medicines may help in the short-term, but they should not be used over the long-term.

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 receive pain medicine if needed. Bed rest is recommended to reduce demands on the heart.

Getting oxygen by a nasal tube or mask worn over the mouth lowers the workload of the heart helping the tissue of the body need less blood.

You may receive intravenous fluids, including blood and blood products, if needed.

Other treatments for shock may include:

• Cardiac catheterization with coronary angioplasty and stenting
• Heart monitoring to guide treatment
• Heart surgery (coronary artery bypass surgery, heart valve replacement, left ventricular assist device)
• Intra-aortic balloon counterpulsation (IABP) to improve heart and blood vessel function
• Pacemaker

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:

• Brain damage
• Kidney damage
• Liver damage

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