Cardiogenic Shock

When the heart does not pump hard enough, blood does not flow well through the body. In severe cases, a poorly pumping heart cannot deliver enough oxygen and nutrients to the lungs, brain, kidneys and other vital organs. This is a condition called "shock." When shock is caused by a problem with the heart, the condition is called cardiogenic shock. This is a serious condition. It occurs in up to 10 percent of people who have had a heart attack.

CAUSES

The most common cause is a heart attack. A heart attack can leave part of your heart unable to pump blood effectively. This can cause your blood pressure to be very low. Other possible causes of cardiogenic shock are:

  • Fluid that builds up around the heart and puts pressure on the heart.

  • A tear in the heart muscle, which changes the way your blood flows.

  • A weak heart that becomes even more weak (cardiomyopathy).

  • Heart failure. The heart is not able to pump blood efficiently. Fluid can leak into the lungs or cause too much fluid to build up in the veins. In severe cases, this can lead to cardiogenic shock.

  • Worsening problems with your heart valves, especially if you have aortic stenosis (when the valve between the heart and aorta, the main artery, does not open fully).

  • Medications such as beta-blockers and calcium channel blockers or drugs that are toxic to the heart. An example would be the cancer drug doxorubicin.

  • A growing tumor in the heart (myxoma).

  • Infection of the heart muscle (myocarditis).

  • A blood clot that blocks the artery that takes blood from the heart to the lungs (pulmonary embolism).

SYMPTOMS

The major signs and symptoms of cardiogenic shock are:

  • Low blood pressure.

  • Sweating.

  • Urinating less often than normal.

  • Feeling nauseous (like you need to vomit).

  • Fainting.

  • Weakness.

  • Pale skin.

  • Cool to cold hands or feet.

  • Shallow, quick breathing.

  • Confusion.

DIAGNOSIS

  • Your blood pressure and other "vital signs" will be taken. You are in shock if the blood pressure is too low (if the top number in the reading is less than 90). Measurements of your pulse (how fast the heart is beating) and your breathing rate are also important.

  • Your appearance will be examined. Being sweaty, pale or having skin with a blue tint is a sign of possible shock.

  • Blood tests might be done to find out whether you have had a heart attack.

  • You will be given an electrocardiogram (called an ECG or EKG) to look for signs of a heart attack.

  • A chest X-ray might be used to see if fluid has built up in your heart or lungs or if your heart is enlarged.

TREATMENT

Treating cardiogenic shock depends on getting blood flowing again in your body, especially in the part of the heart that is damaged. Treatment will take place in the emergency room and intensive care unit of the hospital. It will include:

  • Medication.

  • Surgery to get blood flowing again by creating new, additional or improved blood vessels (revascularization).

  • A procedure that uses a tiny surgical balloon to open arteries and improve blood flow (angioplasty).

  • Surgery to fix any problems with the heart's structure.

  • A heart transplant could be recommended, but this is rare.

PROGNOSIS

There are excellent treatments available for those with cardiogenic shock. However, this is a serious, life-threatening condition. Fast treatment in an emergency medical facility is very important. Factors that affect survival odds include:

  • How fast you are treated for shock.

  • How fast the healthcare team can restore the blood vessel supply to your heart (revascularization).

  • Your age.

  • Past problems with your heart.

  • How healthy you are overall.

  • Any other health conditions you might have.

RELATED COMPLICATIONS

Problems that can result from having cardiogenic shock include:

  • Infection.

  • Repeated surgeries.

  • A long recovery time.

  • Long-term limitations on activities and exercise.

  • Death.

HOME CARE INSTRUCTIONS

When you leave the hospital after a heart attack with cardiogenic shock, you will need to:

  • Take part in rehabilitation programs recommended by your caregiver.

  • Take the medications that your caregiver has prescribed.

  • Gradually increase your physical activity over the next 6 weeks. Work with a rehabilitation program or supervised exercise program to make sure you have the right activities.

  • Return to your caregiver for follow-up appointments or blood tests.

  • Limit driving for at least the first week. Talk with your caregiver before you start driving again.

  • For a month, avoid lifting items that weigh more than 10 pounds.

  • For the first 6 weeks after a heart attack, limit your activities somewhat. However, light housework, hobbies or crafts, shopping or eating out, and light walking will likely be OK.

  • Talk to your caregiver before you do something that requires a lot of arm use, such as hammering, shoveling snow or lifting anything heavier than 30 pounds.

  • Get a medical ID bracelet or necklace in case of emergencies.

  • Quit smoking.

  • Start eating healthy. Your caregiver might ask you to lessen the amount of fat or salt in your diet.

SEEK MEDICAL CARE IF:

  • You have signs of depression. This is common after a heart attack.

  • You occasionally feel dizzy or lightheaded.

  • You feel occasional palpitations (any unpleasant awareness of your heartbeat) or an irregular heartbeat.

  • Your arms or legs start to swell.

  • You feel that you are having problems with medicines prescribed.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have the signs and symptoms of shock.

  • You have heart attack symptoms:

  • Pain in the center of your chest.

  • A sense of your chest being squeezed.

  • Pain in your arms, neck, shoulders or jaw.

  • Shortness of breath, even if you have no chest discomfort.

  • Breaking out in a cold sweat.

  • Nausea.

  • Lightheadedness.

  • You feel dizzy often.

  • Your heart beats fast or unevenly for more than several minutes.

  • You lose consciousness.