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How Is Cardiogenic Shock Diagnosed?

The first step in diagnosing cardiogenic shock is to identify that a person is in shock. At that point, emergency treatment should begin.

Once emergency treatment starts, doctors can look for the specific cause of the shock. If the reason for the shock is that the heart isn't pumping strongly enough, then the diagnosis is cardiogenic shock.

Tests and Procedures To Diagnose Shock and Its Underlying Causes

Blood Pressure Test

Medical personnel can use a simple blood pressure cuff and stethoscope to check whether a person has very low blood pressure. This is the most common sign of shock. A blood pressure test can be done before the person goes to a hospital.

Less serious conditions also can cause low blood pressure, such as fainting or taking certain medicines, such as those used to treat high blood pressure.

EKG (Electrocardiogram)

An EKG is a simple test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular).

An EKG also records the strength and timing of electrical signals as they pass through each part of the heart. Doctors use EKGs to diagnose severe heart attacks and monitor the heart's condition.


Echocardiography (echo) uses sound waves to create a moving picture of the heart. The test provides information about the size and shape of the heart and how well the heart chambers and valves are working.

Echo also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Chest X Ray

A chest x ray takes pictures of organs and structures in the chest, including the heart, lungs, and blood vessels. This test shows whether the heart is enlarged or whether fluid is present in the lungs. These can be signs of cardiogenic shock.

Cardiac Enzyme Test

When cells in the heart die, they release enzymes into the blood. These enzymes are called markers or biomarkers. Measuring these markers can show whether the heart is damaged and the extent of the damage.

Coronary Angiography

Coronary angiography (an-jee-OG-ra-fee) is an x-ray exam of the heart and blood vessels. The doctor passes a catheter (a thin, flexible tube) through an artery in the leg or arm to the heart. The catheter can measure the pressure inside the heart chambers.

Dye that can be seen on an x-ray image is injected into the bloodstream through the tip of the catheter. The dye lets the doctor study the flow of blood through the heart and blood vessels and see any blockages.

Pulmonary Artery Catheterization

For this procedure, a catheter is inserted into a vein in the arm or neck or near the collarbone. Then, the catheter is moved into the pulmonary artery. This artery connects the right side of the heart to the lungs.

The catheter is used to check blood pressure in the pulmonary artery. If the blood pressure is too high or too low, treatment may be needed.

Blood Tests

Some blood tests also are used to help diagnose cardiogenic shock, including:

  • Arterial blood gas measurement. For this test, a blood sample is taken from an artery. The sample is used to measure oxygen, carbon dioxide, and pH (acidity) levels in the blood. Certain levels of these substances are associated with shock.
  • Tests that measure the function of various organs, such as the kidneys and liver. If these organs aren't working well, they may not be getting enough oxygen-rich blood. This could be a sign of cardiogenic shock.
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Last Updated: July 1, 2011