Cardiogenic shock occurs when the heart is unable to pump enough blood to the vital organs in the body. This is a life-threatening condition that requires immediate medical attention. Cardiogenic shock is most often caused by a heart attack. Some 40,000 to 50,000 Americans each year experience cardiogenic shock.
Cardiogenic shock stages
Cardiogenic shock severity is assessed using shock stages called SCAI Shock Classification How severe cardiogenic shock is at diagnosis can influence treatment urgency and may affect a patient's risk of serious complications during their hospital stay. There are five stages of cardiogenic shock ranging from at risk to being critically ill. These stages are:
- A–At Risk: Heart disease, but signs of shock.
- B–Beginning: Low blood pressure or heart rate.
- C–Classic: Need for medication or cardiac devices to help the heart pump blood to the organs.
- D–Deteriorating: Failure to respond to medicine or devices.
- E–Extremis: Cardiac arrest that needs resuscitation, mechanical life support and defibrillator.
Cardiogenic shock symptoms
The onset of signs and symptoms of cardiogenic shock can occur very quickly, so it is extremely important to call 911 or immediately go to the emergency room. Symptoms may include:
- Chest pain that lasts for more than a few minutes or decreases and then returns
- Sudden shortness of breath or trouble breathing
- Fainting or dizziness
- Feeling lightheaded and/or anxious
- Rapid, but weak heartbeat
- Sweating and cold extremities, like fingers and toes
- Fatigue
- Confusion and anxiety
Cardiogenic shock most commonly develops after a severe heart attack. If any of these symptoms occur after a heart attack this might be an indication of cardiogenic shock:
- Persistent chest pain
- Worsening breathing problems
- Sudden weakness
- Sweating
- Falling or very low blood pressure
Cardiogenic shock causes
The most common cause is a heart attack, but other conditions may include:
- Pulmonary embolism - blood clot in the lung
- Ventricular tachycardia - lower chambers of the heart beat faster than 100 beats per minute
- Ventricular fibrillation - lower chambers of the heart begin quivering or twitching
- Heart failure - heart fails to pump enough blood to the vital organs
- Pericardial tamponade - fluid or blood build up in the membrane that surrounds the heart
- Myocarditis - inflammation of the heart muscle
- Heart valve disease - one or more of the heart valves do not open or close properly
Diagnosis and tests
Cardiogenic shock is often diagnosed in the emergency room. During the physical examination, the healthcare provider may find symptoms of cardiogenic shock which include:
- Low blood pressure
- Weak pulse
- Cold and clammy skin
- Abnormal heart rhythm or heart murmur
The test performed include:
- Blood pressure monitoring
- ECG
- Echocardiogram
- Chest x-ray
- Cardiac catheterization
- Blood tests
Cardiogenic shock treatment
Cardiogenic shock is a life-threatening medical condition which requires immediate medical attention to improve blood and oxygen flow to the major organs.
Treatment often begins in a hospital emergency room or critical care unit and includes:
- Oxygen to assist breathing
- IV medications to improve blood flow, help remove excess fluids and support heart function
- Placement of a central line to monitor pressures inside of the heart
Once the initial emergency treatment is complete, additional medical intervention is dependent on the underlying cause(s) of cardiogenic shock, such as:
- Heart attack and coronary artery blockage: Angioplasty with or without a stent or open heart surgery
- Heart valve problems: Heart valve replacement or repair
- Fluid buildup around the heart: Pericardiocentesis, a procedure that uses a needle to remove excess fluid the compresses the heart
Critically ill patients may require Extracorporeal Membrane Oxygenation (ECMO) or other devices to temporarily assume the workload from the heart and lungs.
If the heart function is not expected to improve, patients may be evaluated for a left ventricular assist device (LVAD) or a heart transplant.