Understanding Cardiogenic Shock

Cardiogenic shock is a type of shock. Shock occurs when the body’s vital organs don't get enough oxygen-carrying blood.

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What is cardiogenic shock?

Heart showing two coronary arteries, with detail of artery narrowed by plaque.

Cardiogenic shock is a type of shock. Shock occurs when the body’s vital organs don't get enough oxygen-carrying blood. Without enough oxygen to fuel its parts, the body can’t work correctly and death may occur. With cardiogenic shock, the heart is not able to pump enough blood to the brain, other vital organs, and throughout the body. Shock can happen in several other ways, such as from:

  • Blood loss (hypovolemic shock)

  • Overwhelming infection (septic shock)

  • Severe allergic reaction (anaphylactic shock)

  • Injury to the spinal cord (neurogenic shock)

All forms of shock are considered a life-threatening emergency and need to be treated right away.

What causes cardiogenic shock?

Cardiogenic shock is most often caused by a heart attack due to coronary artery disease. But it can occur from any health problem that disrupts blood flow to and from the heart. These include:

  • Irregular heartbeat

  • Heart failure

  • Heart defects

  • Valve disease

  • Blood clot in the lungs

  • Injury to the chest

  • Internal bleeding

  • Overdose from medicine or an illegal drug

What are the symptoms of cardiogenic shock?

The symptoms of cardiogenic shock can vary from person to person. The condition often starts with a drop in blood pressure, causing these symptoms:

  • Confusion

  • Fast breathing and severe shortness of breath

  • Weak or irregular pulse

  • Bulging veins in the neck

  • Dizziness

  • Nausea

  • Cold, clammy skin

  • Fainting

  • Urinating less or not at all

  • Fever

How is cardiogenic shock diagnosed?

Cardiogenic shock is usually diagnosed in the hospital, after you’ve been admitted for a possible heart attack or symptoms of shock. Your doctor will ask about your medical history, do a physical exam, and may order some tests. These tests may include:

  • Chest X-ray. This is an imaging test to look at the structures in and around your chest.

  • Coronary angiography. This test uses contrast material and X-ray images to find blockages in the coronary arteries.

  • Echocardiography. This procedure uses sound waves to create moving pictures of your heart. The pictures show the size and shape of your heart, and how well your heart is pumping blood.

  • Electrocardiogram (EKG or ECG). During this test, electrodes are placed on your skin to record your heart’s electrical activity. It can show how fast your heart is beating, if the rhythm is steady or irregular, and signs of a heart attack or other heart abnormalities.

How is cardiogenic shock treated?

Cardiogenic shock is a life-threatening emergency needing immediate treatment. Treatment for cardiogenic shock focuses on raising blood pressure, restoring blood flow to and from the heart, and reversing the underlying cause. It may include:

  • Support therapies. These include oxygen or fluids. A ventilator may also be used to help with breathing.

  • Medicines. The doctor may prescribe medicines to help with problems like low blood pressure, an irregular heartbeat, or a blood clot in an artery.

  • Percutaneous cardiac intervention (PCI). This procedure can restore blood flow to and from the heart if an artery is blocked. Using live X-rays, a specialized doctor guides a small plastic tube (catheter) through the arteries to the blockage. They then insert a small balloon or mesh tube (stent) into the artery to open it.

  • Coronary artery bypass grafting (CABG). This surgical procedure is open-heart surgery and may be done if PCI would not be an effective enough treatment for the problem. This treatment bypasses a blocked artery. A surgeon takes a healthy blood vessel from somewhere else in the body. They use it to reroute blood flow around the blockage.

  • Medical devices. The heart may need help pumping blood for a short time or longer. Medical devices like a ventricular assist device or intra-aortic balloon pump may be used. These can help give the heart time to recover. Or they can support the heart for a time until other treatments can be done.

  • Heart transplant. If other treatments don’t work, a heart transplant may be an option. This is a surgery done to remove the diseased heart and replace it with a healthy one from an organ donor.

What are the complications of cardiogenic shock?

Cardiogenic shock can lead to these health problems:

  • Irregular heartbeat

  • Cardiac arrest

  • Kidney or liver failure

  • Brain damage

  • Heart attack

  • Stroke

  • Death