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Overview
What is cardiogenic shock?
Cardiogenic shock is a medical emergency that results when the heart has been damaged so much that it can’t supply enough blood and oxygen to the body. The most common causes are serious heart conditions such as a heart attack (myocardial infarction) or advanced congestive heart failure caused by severe heart muscle damage or other abnormalities. These complications include:
- A large section of heart muscle that no longer moves well or does not move at all
- Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation or supraventricular tachycardia
- Very slow heart rhythm (bradycardia) or other problems with the electrical conduction system of the heart (heart block)
- Breaking open (rupture) of the heart muscle or walls inside the heart due to damage from the heart attack
- Tear or rupture of specific muscles or tendons that are necessary for adequate functioning of the heart valves
- Pressure on the heart due to a buildup of fluid around it (pericardial tamponade)
What are symptoms of cardiogenic shock?
Cardiogenic shock occurs when the heart can’t pump as much blood as the body needs. Patients may suffer from a variety of symptoms when this occurs including:
- Chest pain or pressure
- Fast breathing or shortness of breath
- Fast pulse
- Heavy sweating, moist skin or skin that feels cool to the touch
- Pale skin color or blotchy skin
- Weak (thready) pulse
- Decreased urination
- Lightheadedness, restlessness, agitation, confusion, loss of alertness and ability to concentrate
- Loss of consciousness
Complications may include:
- Brain damage
- Kidney damage
- Liver damage
Go to the emergency room or call 9-1-1 if you have symptoms of cardiogenic shock. Cardiogenic shock is a medical emergency.
How doctors diagnose cardiogenic shock
An exam will show:
- Low blood pressure (most often less than 90 mm Hg systolic)
- Weak (thready) pulse
- Cold and clammy skin
To diagnose cardiogenic shock, numerous tests can be used to determine the actual reason for the shock and to help guide treatment. These include:
- Electrocardiogram
- Chest x-ray
- Echocardiogram
- Nuclear scan of the heart
- Cardiac catheterization
- Coronary angiography
Other blood tests may be done to find problems that either contribute to the shock or show clear abnormalities because of the heart not working properly. These include:
- Blood chemistry (chem-7, chem-20, electrolytes, lactic acid level)
- Cardiac enzymes (troponin, CKMB)
- Complete blood count (CBC)
- Arterial blood gas
- Thyroid stimulating hormone (TSH)
Cardiogenic shock emergency treatment
Cardiogenic shock is a medical emergency. Even with fast and appropriate treatment, survival and complication rates are high. When cardiogenic shock is not treated, survival is almost impossible. You will need to stay in the hospital, most often in the Intensive or Coronary Care Unit (ICU) to receive the highest level of care. The goal of treatment is to find and treat the cause of shock to save your life.
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Heart devices
In some patients, despite being treated with all the appropriate and aggressive interventions, surgeries and medications, the heart can get larger and weaker. Patients may need extra support to help cardiac function or be protected from life-threatening arrythmias and sudden cardiac arrest, by a protective device called an ICD.
Devices include:
- An implantable cardioverter defibrillator or ICD
- A biventricular ICD (cardiac resynchronization therapy)
- A mechanical heart pump (a ventricular assist device (VAD) or a total artificial heart)
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Procedures or surgery
Life-threatening electrical system abnormalities may complicate shock further. When a serious and heart rhythm disturbance (arrhythmia) occurs, urgent treatment may be needed to restore a normal heart rhythm. This may include:
- Medicines given through a vein (IV)
- Electrical “shock” therapy (defibrillation or cardioversion)
- Implanting a temporary or even permanent pacemaker
Other treatments for shock may include:
- Heart monitoring to guide treatment
- Cardiac catheterization with coronary angioplasty and stenting if blocked arteries and an acute heart attack are the underlying problem.
- Heart surgery (coronary artery bypass surgery, heart valve replacement, left ventricular assist device)
- Intra-aortic balloon counterpulsation (IABP) to temporarily help the heart work better until definitive treatment such as angioplasty, stenting or surgery can be performed to stabilize the patient
- Pacemaker if a slow heart rate is either contributing the shock or resulting from the heart damage that caused shock in the first place
- Ventricular assist device or other mechanical support to help support heart function and blood flow when the heart muscle is unable to pump enough blood on its own.
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Medication
Initial medicines designed to stabilize patients with shock might include:
- Fluids, blood, and blood products through a vein (IV)
- Pain medicine
- Oxygen
Patients may also need intravenous medicines to increase blood pressure and improve heart function. These include:
- Dobutamine
- Dopamine
- Epinephrine
- Levosimendan
- Milrinone
- Norepinephrine
- Vasopressi
These medicines may help in the short term. They are not used for long term treatment.
How to prevent cardiogenic shock
You may reduce the risk of developing cardiogenic shock by:
- Preventing and treating the risk factors for heart disease, such as diabetes, high blood pressure, high cholesterol and triglycerides, or tobacco use
- Immediately seeking medical attention when you experience new or significant symptoms that you suspect may be coming from your heart, especially if you are at high risk for heart problems or already have known heart disease
- Quickly treating its cause (such as heart attack or heart valve problem). The more rapidly care can be administered to provide supportive care and correct the source of the problem, the higher the chances of surviving shock and avoiding major complications associated with it.
Cardiogenic shock treatment near you
Cardiology services at Ballad Health
Our extensive network of highly trained cardiologists, surgeons and advanced practice providers are here to support you and help you navigate a heart-related diagnosis.
Learn more about heart and vascular services at Ballad Health.
CVA Heart Institute Learning Center
We understand that receiving a cardiogenic shock diagnosis can be overwhelming. Our goal is to alleviate your fears and help you to understand your condition.
We have an informational video library, education tools and heart-related FAQs so that you have the resources you need.
Heart care patient stories
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Read our patient stories
Our patients inspire us every day, and we’re honored when they trust us with their care. They tell their stories best, so we’ve gathered a few here to share with you.
Many of these patients received life-saving care for heart conditions when they weren’t experiencing any symptoms. These experiences have changed they way they look at their individual care and helped them see the importance of regular preventive screenings.