Learn About Cardiogenic Shock

What is the definition of Cardiogenic Shock?

Cardiogenic shock takes place when the heart has been damaged so much that it is unable to supply enough blood to the organs of the body.

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What are the alternative names for Cardiogenic Shock?

Shock - cardiogenic

What are the causes of Cardiogenic Shock?

The most common causes are serious heart conditions. Many of these occur during or after a heart attack (myocardial infarction). These complications include:

  • A large section of heart muscle that no longer moves well or does not move at all
  • Breaking open (rupture) of the heart muscle due to damage from the heart attack
  • Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia
  • Pressure on the heart due to a buildup of fluid around it (pericardial tamponade)
  • Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve
  • Tear or rupture of the wall (septum) between the left and right ventricles (lower heart chambers)
  • Very slow heart rhythm (bradycardia) or problem with the electrical system of the heart (heart block)
Heart - section through the middle

Cardiogenic shock occurs when the heart is unable to pump as much blood as the body needs. It can happen even if there hasn't been a heart attack if one of these problems occurs and your heart function drops suddenly.

What are the symptoms of Cardiogenic Shock?

Symptoms include:

  • Chest pain or pressure
  • Coma
  • Decreased urination
  • Fast breathing
  • Fast pulse
  • Heavy sweating, moist skin
  • Lightheadedness
  • Loss of alertness and ability to concentrate
  • Restlessness, agitation, confusion
  • Shortness of breath
  • Skin that feels cool to the touch
  • Pale skin color or blotchy skin
  • Weak (thready) pulse
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What are the current treatments for Cardiogenic Shock?

Cardiogenic shock is a medical emergency. You will need to stay in the hospital, most often in the Intensive Care Unit (ICU). The goal of treatment is to find and treat the cause of shock to save your life.

You may need medicines to increase blood pressure and improve heart function, including:

  • Dobutamine
  • Dopamine
  • Epinephrine
  • Levosimendan
  • Milrinone
  • Norepinephrine
  • Vasopressin

These medicines may help in the short-term. They are not often used for a long time.

When a heart rhythm disturbance (dysrhythmia) is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include:

  • Electrical "shock" therapy (defibrillation or cardioversion)
  • Implanting a temporary pacemaker
  • Medicines given through a vein (IV)

You may also receive:

  • Pain medicine
  • Oxygen
  • Fluids, blood, and blood products through a vein (IV)

Other treatments for shock may include:

  • Cardiac catheterization with coronary angioplasty and stenting
  • Heart monitoring to guide treatment
  • Heart surgery (coronary artery bypass surgery, heart valve replacement, left ventricular assist device)
  • Intra-aortic balloon counterpulsation (IABP) to help the heart work better
  • Pacemaker
  • Ventricular assist device or other mechanical support
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What is the outlook (prognosis) for Cardiogenic Shock?

In the past, the death rate from cardiogenic shock ranged from 80% to 90%. In more recent studies, this rate has decreased to 50% to 75%.

When cardiogenic shock is not treated, the outlook is very poor.

What are the possible complications of Cardiogenic Shock?

Complications may include:

  • Brain damage
  • Kidney damage
  • Liver damage
When should I contact a medical professional for Cardiogenic Shock?

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of cardiogenic shock. Cardiogenic shock is a medical emergency.

How do I prevent Cardiogenic Shock?

You may reduce the risk of developing cardiogenic shock by:

  • Quickly treating its cause (such as heart attack or heart valve problem)
  • Preventing and treating the risk factors for heart disease, such as diabetes, high blood pressure, high cholesterol and triglycerides, or tobacco use
What are the latest Cardiogenic Shock Clinical Trials?
JENA Mechanical Assist Circulatory Support Trial-JENAMACS-hemodynamic
Summary: Prospective, monocentric open-label observational study for the assessment of acute hemodynamic effects following implantation of the IMPELLA CP cardiac support device
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Effects of Advanced Mechanical Circulatory Support in Patients With ST Segment Elevation Myocardial Infarction Complicated by Cardiogenic Shock. The Danish Cardiogenic Shock Trial
Summary: Cardiogenic shock a serious complication of a heart attack (myocardial infarction). Despite rapid invasive treatment, circulatory support using positive inotropes and mechanical support with intra-aortic balloon counterpulsation (IABP), and evaluation of several new treatments during the last decade, the mortality in patients with cardiogenic shock still exceeds 50%. An alternative to current mana...
What are the Latest Advances for Cardiogenic Shock?
Neonatal MIS-C: Managing the Cytokine Storm.
Summary: Neonatal MIS-C: Managing the Cytokine Storm.
Newer P2Y12 Inhibitors vs Clopidogrel in Acute Myocardial Infarction With Cardiac Arrest or Cardiogenic Shock: A Systematic Review and Meta-analysis.
Summary: Newer P2Y12 Inhibitors vs Clopidogrel in Acute Myocardial Infarction With Cardiac Arrest or Cardiogenic Shock: A Systematic Review and Meta-analysis.
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Overview of mitral valve replacement versus mitral valve repair due to ischemic papillary muscle rupture: A meta-analysis inspired by a case report.
Summary: Overview of mitral valve replacement versus mitral valve repair due to ischemic papillary muscle rupture: A meta-analysis inspired by a case report.
Who are the sources who wrote this article ?

Published Date: June 25, 2020
Published By: Micaela Iantorno, MD, MSc, FAHA, RPVI, Interventional Cardiologist at Mary Washington Hospital Center, Fredericksburg, VA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

What are the references for this article ?

Felker GM, Teerlink JR. Diagnosis and management of acute heart failure. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 24.

Hollenberg SM. Cardiogenic shock. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 99.