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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.

Causes

The most common causes are serious heart conditions. 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
  • 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)
Heart, section through the middle

Cardiogenic shock occurs when the heart is unable to pump as much blood as the body needs. It can happen even if there hasn't been a heart attack if 1 of these problems occurs and your heart function drops suddenly.

Symptoms

Symptoms include:

  • Chest pain or pressure
  • Coma
  • Decreased urination
  • Fast breathing
  • Fast pulse
  • Heavy sweating, moist skin
  • Lightheadedness
  • Loss of alertness and ability to concentrate
  • Restlessness, agitation, confusion
  • 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 systolic)
  • Blood pressure that 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 well.

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, most often in the Intensive 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

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:

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 poor.

Possible Complications

Complications may include:

When to Contact a Medical Professional

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

Alternative Names

Shock - cardiogenic

References

Felker GM, Teerlink JR. Diagnosis and management of acute heart failure. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 24.

Hollenberg S. Cardiogenic shock. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 107.

Review Date 5/5/2016

Updated 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 Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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