Definition

Cardiogenic shock is a life-threatening condition where the heart is suddenly unable to pump enough blood to meet the body's needs.

Causes

Cardiogenic shock is typically caused by a severe heart attack, but not everyone who has a heart attack develops cardiogenic shock. In a heart attack, there is a lack of oxygen supply to the heart, causing damage to the heart muscle, particularly the left ventricle, which pumps blood around the body. The weakness of the heart muscle is what causes cardiogenic shock. Damage to the right ventricles muscle can also cause cardiogenic shock although the frequency is rarer.

Other causes of cardiogenic shock are:

• Inflammation of the heart muscle (myocarditis)
• Heart valve infection (endocarditis)
• Weakness of the heart from other causes
• Drug overdose or substance poisoning that may affect the pumping ability of the heart

Risk factor

If you've had a heart attack, the risk of cardiogenic shock increases if you:

• Are older
• Have a previous history of heart failure or heart attack
• Have coronary heart disease in some of the heart's blood vessels
• Have diabetes or high blood pressure
• Are overweight or obese
• Female

Symptoms

Signs and symptoms of cardiogenic shock include:

• Rapid breathing
• Severe shortness of breath
• Rapid heartbeat
• Loss of consciousness
• Weak pulse
• Low blood pressure (hypotension)
• Sweating
• Pale skin
• Cold hands and feet
• Urinating less than usual or not urinating at all

Since cardiogenic shock usually occurs in people with severe heart attacks, it is also important to know the symptoms and signs of a heart attack, such as:

• A sensation of pressure, fullness, or pain in the chest that lasts for more than a few minutes
• Pain radiating to the shoulders, arms, back, teeth, or jaw
• Chest pain that increases in severity with each episode
• Shortness of breath
• Sweating
• Sudden feeling of lightheadedness or dizziness
• Nausea and vomiting

Diagnosis

Cardiogenic shock is typically diagnosed in an emergency department. The doctor will look for signs of shock and perform an examination. The examination includes:

• Blood pressure reading. People with shock have very low blood pressure
• Electrocardiogram (ECG). This is a quick and easy test to do. The aim is to record the electrical activity of the heart through electrodes placed on the skin. If the heart muscle is damaged or if there is a buildup of fluid around the heart, the heart will not send normal electrical signals
• Chest X-ray. This test can show the size and shape of the heart, as well as fluid buildup in the lungs
• Blood test. This is used to look for organ damage, infection, and heart attack. In addition, a blood gas test can also be done to measure oxygen levels in the blood
• This examination uses sound waves to produce images of the heart so that damage from a heart attack can be seen
• Cardiac catheterization (angiography). This test can determine whether any of the heart's blood vessels are blocked or narrowed. The doctor will place a small, long tube (catheter) through a blood vessel in the leg or arm and into the heart. The heart's blood vessels will be seen on an X-ray

Management

The goal of treating cardiogenic shock is to reduce damage to the heart and other organs caused by lack of oxygen. Most people with cardiogenic shock will need oxygen support for breathing. A breathing machine or ventilator may help if necessary. You will also receive injections that improve the heart's pumping ability and lower the risk of blood clot formation. These drugs are:

• Medications for low blood pressure, such as dopamine, epinephrine, norepinephrine
• Drugs to increase the heart muscle's ability to pump blood, e.g. dobutamine, dopamine
• Aspirin to reduce blood clots so that blood flow is not interrupted
• Aspirin-like drugs to prevent blood clots from forming, such as clopidogrel, ticagrelor
• Other blood-thinning medications such as heparin. Heparin is usually given in the first few days after a heart attack

Apart from medications, several medical procedures can be performed to restore blood flow to the heart, including:

• Angioplasty and 'heart ring' stents. If a blockage is discovered during a cardiac catheterization examination, the doctor can insert a balloon-tipped catheter into the blocked blood vessel. The balloon will be inflated to open the blockage. A stent may then be placed to keep the blood vessel open
• Balloon pump. The doctor may insert a balloon pump into the aorta (the main blood vessel coming out of the heart). This pump inflates and deflates inside the aorta, increasing blood flow and decreasing the heart's workload
• Extracorporeal membrane oxygenation (ECMO). This device improves blood flow and oxygen delivery to the body by pumping your blood out of your body into a heart-lung machine, which will remove carbon dioxide and return oxygen-rich blood to the body

If the medications and medical procedures listed above do not relieve the cardiogenic shock, your doctor may recommend surgery to address the underlying cause. If surgery fails, the final option is a heart transplant.

Complications

Cardiogenic shock frequently results in death if not treated promptly. Another serious complication is damage to the liver, kidneys, and other organs as a result of insufficient oxygen. This damage can be permanent.

Prevention

The best way to prevent cardiogenic shock is to maintain good heart health. Maintaining a healthy heart requires a healthy lifestyle and stable blood pressure, which can be achieved by:

• Quit smoking and avoid exposure to cigarette smoke
• Maintain an ideal body weight. Being overweight increases the risk of high blood pressure, heart disease, and diabetes, all of which contribute to the development of heart attacks and cardiogenic shock
• Reducing foods high in cholesterol and saturated fat can lower your risk of heart disease
• Reduce salt consumption. Too much salt leads to fluid buildup in the body, making it difficult for the heart to function. The recommended daily salt intake is less than 2.3 grams. In addition to cooking salt, salt can be found in canned or processed foods. It is recommended that you check the salt content before eating these foods
• Reduce sugar consumption. This can help you reduce consumption of nutrient-poor calorie foods, which can help you maintain your weight
• Limit alcohol consumption to a maximum is one drink for women and two drinks for men
• Exercise regularly. Exercise can lower blood pressure and improve blood vessels and heart health. It is recommended that you exercise for at least 150 minutes of moderate aerobic or 75 minutes of vigorous aerobic activity per week

When to see a doctor?

If you have symptoms of a heart attack or cardiogenic shock, call an emergency number immediately and avoid driving yourself because it is dangerous. Immediate treatment for a heart attack increases life expectancy and minimizes heart damage.

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