Cardiogenic Shock

Cardiogenic shock is a sudden and life-threatening condition where the heart cannot pump enough blood to the vital organs in the body. Without prompt treatment, this condition is often rapidly fatal.

Causes and Risk Factors

The most common cause for cardiogenic shock is a severe heart attack. A heart attack occurs when there is a lack of oxygen-rich blood flow to the heart muscle leading to damage to the pumping chambers of the heart. This damage can cause sudden weakening of the heart’s pumping function, leading to cardiogenic shock.
Cardiogenic shock can also occur:

  • After heart surgery
  • Acute heart failure from other conditions than a heart attack
  • Acute worsening of chronic heart failure
  • Myocarditis (inflammation of the heart muscle)
  • Endocarditis (infection of the heart valves)

Symptoms

When a patient experiences cardiogenic shock, their blood pressure is very low; this is a sign that the heart is unable to pump enough blood to vital organs. Patients may also experience the following signs and symptoms:

  • Shortness of breath
  • Rapid breathing
  • Rapid heart beat
  • Low blood pressure
  • Loss of consciousness
  • Confusion
  • Pale and/or cool skin
  • Sweating
  • Decreased amount of urination

Diagnosis

The diagnosis of cardiogenic shock is typically made in the hospital setting by a doctor. Since a common cause of cardiogenic shock is a heart attack, it is important to know the signs and symptoms of a heart attack. If you were to experience any of the following, you should seek medical attention quickly:

  • Chest pain or pressure in the center of your chest
  • Pain radiating into your shoulders, neck, jaw or arms
  • Shortness of breath
  • Sweating
  • Lightheadedness or dizziness
  • Nausea and/or vomiting

Doctors will suspect cardiogenic shock in patients based on their symptoms and vital signs. Further testing can help confirm the diagnosis. Tests typically include:

  • Electrocardiogram (ECG) – A recording of your heart’s electrical activity is done by attaching electrodes to the skin of your chest. Specific patterns on an ECG may indicate a heart attack or electrical abnormality of the heart.
  • Chest X-ray – This test helps your doctor visualize your heart’s shape and size. In addition, the chest x-ray will demonstrate whether there is fluid build-up in your lungs.
  • Blood tests – Blood tests are used to measure the function of your organs and the amount of oxygen in your blood.
  • Echocardiogram – This ultrasound test evaluates the function of your heart’s pumping chambers and valves.
  • Cardiac catheterization – This procedure involves inserting a tube into an artery either in your arm or leg in order to inject dye into the arteries that supply blood to the heart to look for blockages. In addition, a catheter placed in a vein can make pressure measurements in your heart and lungs and evaluate the heart’s ability to pump blood to the rest of the body.

Treatment

Patients with cardiogenic shock require prompt treatment in order to restore blood flow to vital organs. Treatment can include any or all of the following:

  • Intravenous medications can help to increase the heart’s pumping function and raise blood pressure to improve the blood flow. 
  • Angioplasty and stenting of heart arteries can restore blood flow to the heart muscle. However, many patients will continue to worsen despite these treatments. 
  • Mechanical circulatory support devices may be required to stabilize the patient. These devices include miniaturized heart pumps that can be placed through large blood vessels and extracorporeal membrane oxygenation (ECMO) in which an externalized heart pump circulates oxygenated blood to the body. Treating a cardiogenic shock patient with mechanical circulatory support devices give the heart time to recover or bridge the patient to either a long-term heart assist device called an LVAD (left ventricular assist device) or heart transplantation.

CUIMC/NYP Cardiogenic Shock Team

NYP/CUIMC Cardiogenic Shock response team with patient

Columbia University Irving Medical Center/NewYork-Presbyterian Hosptial uses a shock team approach to provide rapid, multidisciplinary assessment of cardiogenic shock patients by a team comprised of heart failure cardiologists, interventional cardiologists and heart surgeons. Our Cardiogenic Shock team is available 24 hours a day, 7 days a week to provide immediate evaluation and management of cardiogenic shock patients.

If you are a physician, please contact 1-800-NYP-STAT (1-800-697-7828) to have your patient evaluated by our multidisciplinary team and considered for transfer.