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Cardiogenic shock

Definition

Cardiogenic shock is a disease state where the heart is damaged enough that it is unable to supply sufficient blood to the body.

Alternative Names

Shock - cardiogenic

Causes, incidence, and risk factors

Shock occurs whenever the heart is unable to pump enough blood for the needs of the body. Cardiogenic shock can be caused by disorders of the heart muscle, the valves, or the heart's electrical conduction system.

Some related disorders include heart attack, heart failure, cardiomyopathy, rupture of the heart, abnormal heart rhythms, and heart valve disorders (especially leaky valves).

Symptoms

• Rapid pulse
• Pulse may be weak (thready)
• Rapid breathing
• Anxiety, nervousness
• Skin may feel cool to touch
• Weakness, lethargy, fatigue
• Decreased mental status
  • Loss of alertness
  • Loss of ability to concentrate
• Restlessness, agitation, confusion
• Coma
• Skin color pale or mottled
• Profuse sweating, moist skin
• Decreased urine output (or none)

Signs and tests

An examination will reveal low blood pressure (less than 90 systolic), and the blood pressure may drop more than 10 points when the patient stands up after lying down (orthostatic hypotension). The pulse may be weak or absent.

To diagnose cardiogenic shock, a catheter (tube) may be placed in the pulmonary artery. Measurements often indicate that blood is backing up into the lungs and that the heart has poor pumping function.

Tests used in patients with cardiogenic shock include:

• Electrocardiogram
• Coronary angiography
• Echocardiogram
• Nuclear scans

Other tests may be recommended to determine the cause of the heart's failure to function properly.

Laboratory tests include:

• CBC
• Type and cross-match blood for possible transfusion
• Arterial blood gas
• Blood chemistry (chem-7, chem-20, electrolytes, cardiac enzymes)

Treatment

Cardiogenic shock is a medical emergency. Treatment requires hospitalization. The goal of treatment is to save the patient's life and treat the underlying cause of shock.

Dopamine, dobutamine, epinephrine, norepinephrine, amrinone, or other medications may be required to increase blood pressure and heart functioning. Pain medicine may be given if necessary. Bed rest is recommended to reduce demands on the heart.

Oxygen reduces the workload of the heart by reducing tissue demands for blood flow.

Intravenous fluids, including blood and blood products, may be given if indicated.

Other treatments of shock may include:

• Cardiac pacing (pacemaker)
• Heart monitoring, including hemodynamic monitoring, to guide treatment
• Intra-aortic balloon counterpulsation (IABP) to improve heart and blood vessel (cardiovascular) function

Note: Surgical repair of the cause should be performed if it is feasible. Balloon angioplasty (PTCA) may be an alternative to surgery in some cases.

Expectations (prognosis)

Approximately 80% of cases of cardiogenic shock are fatal, even with treatment.

Complications

• Kidney damage
• Brain damage
• Liver damage

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if symptoms are present. Cardiogenic shock is a medical emergency.

Prevention

The risk may be reduced by prompt, aggressive treatment of related disorders.

Review Date:5/31/2006
Reviewed By:Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network.

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