Cardiogenic (kar-dee-oh-JE-nik) shock is a condition in which a suddenly weakened heart isn't able to pump enough blood to meet the body's needs. The condition is a medical emergency and is fatal if not treated right away.
The most common cause of cardiogenic shock is damage to the heart muscle from a severe heart attack. However, not everyone who has a heart attack has cardiogenic shock. In fact, on average, only about 7 percent of people who have heart attacks develop the condition.
If cardiogenic shock does occur, it's very dangerous. When people die from heart attacks in hospitals, cardiogenic shock is the most common cause of death.
The medical term "shock" refers to a state in which not enough blood and oxygen reach important organs in the body, such as the brain and kidneys. Shock causes very low blood pressure and may be life threatening.
Shock can have many causes. Cardiogenic shock is only one type of shock. Other types of shock include hypovolemic (hy-po-vo-LEE-mik) shock and vasodilatory (VAZ-oh-DILE-ah-tor-e) shock.
Hypovolemic shock is a condition in which the heart can’t pump enough blood to the body because of severe blood loss.
In vasodilatory shock, the blood vessels suddenly relax. When the blood vessels are too relaxed, blood pressure drops and blood flow becomes very low. Without enough blood pressure, blood and oxygen don’t reach the body’s organs.
A bacterial infection in the bloodstream, a severe allergic reaction, or damage to the nervous system (brain and nerves) may cause vasodilatory shock.
When a person is in shock (from any cause), not enough blood and oxygen are reaching the body's organs. If shock lasts more than a few minutes, the lack of oxygen starts to damage the body’s organs. If shock isn't treated quickly, it can cause permanent organ damage or death.
Some of the signs and symptoms of shock include:
If you think that you or someone else is in shock, call 9–1–1 right away for emergency treatment. Prompt medical care can save your life and prevent or limit damage to your body’s organs.
In the past, almost no one survived cardiogenic shock. Now, about half of the people who go into cardiogenic shock survive. This is because of prompt recognition of symptoms and improved treatments, such as medicines and devices. These treatments can restore blood flow to the heart and help the heart pump better.
In some cases, devices that take over the pumping function of the heart are used. Implanting these devices requires major surgery.
Cardiogenic shock occurs if the heart suddenly can't pump enough oxygen-rich blood to the body. The most common cause of cardiogenic shock is damage to the heart muscle from a severe heart attack.
This damage prevents the heart’s main pumping chamber, the left ventricle (VEN-trih-kul), from working well. As a result, the heart can't pump enough oxygen-rich blood to the rest of the body.
In about 3 percent of cardiogenic shock cases, the heart’s lower right chamber, the right ventricle, doesn’t work well. This means the heart can't properly pump blood to the lungs, where it picks up oxygen to bring back to the heart and the rest of the body.
Without enough oxygen-rich blood reaching the body’s major organs, many problems can occur. For example:
How well the brain, kidneys, and other organs recover will depend on how long a person is in shock. The less time a person is in shock, the less damage will occur to the organs. This is another reason why emergency treatment is so important.
The underlying causes of cardiogenic shock are conditions that weaken the heart and prevent it from pumping enough oxygen-rich blood to the body.
Most heart attacks occur as a result of coronary heart disease (CHD). CHD is a condition in which a waxy substance called plaque (plak) narrows or blocks the coronary (heart) arteries.
Plaque reduces blood flow to your heart muscle. It also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.
Heart attacks can cause some serious heart conditions that can lead to cardiogenic shock. One example is ventricular septal rupture. This condition occurs if the wall that separates the ventricles (the heart’s two lower chambers) breaks down.
The breakdown happens because cells in the wall have died due to a heart attack. Without the wall to separate them, the ventricles can’t pump properly.
Heart attacks also can cause papillary muscle infarction or rupture. This condition occurs if the muscles that help anchor the heart valves stop working or break because a heart attack cuts off their blood supply. If this happens, blood doesn't flow correctly between the heart’s chambers. This prevents the heart from pumping properly.
Serious heart conditions that may occur with or without a heart attack can cause cardiogenic shock. Examples include:
Pulmonary embolism (PE) is a sudden blockage in a lung artery. This condition usually is caused by a blood clot that travels to the lung from a vein in the leg. PE can damage your heart and other organs in your body.
The most common risk factor for cardiogenic shock is having a heart attack. If you've had a heart attack, the following factors can further increase your risk for cardiogenic shock:
Women who have heart attacks are at higher risk for cardiogenic shock than men who have heart attacks.
A lack of oxygen-rich blood reaching the brain, kidneys, skin, and other parts of the body causes the signs and symptoms of cardiogenic shock.
Some of the typical signs and symptoms of shock usually include at least two or more of the following:
Any of these alone is unlikely to be a sign or symptom of shock.
If you or someone else is having these signs and symptoms, call 9–1–1 right away for emergency treatment. Prompt medical care can save your life and prevent or limit organ damage.
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.
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.
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.
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.
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 (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.
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.
Some blood tests also are used to help diagnose cardiogenic shock, including:
Cardiogenic shock is life threatening and requires emergency medical treatment. The condition usually is diagnosed after a person has been admitted to a hospital for a heart attack. If the person isn't already in a hospital, emergency treatment can start as soon as medical personnel arrive.
The first goal of emergency treatment for cardiogenic shock is to improve the flow of blood and oxygen to the body’s organs.
Sometimes both the shock and its cause are treated at the same time. For example, doctors may quickly open a blocked blood vessel that's damaging the heart. Often, this can get the patient out of shock with little or no additional treatment.
Emergency life support treatment is needed for any type of shock. This treatment helps get oxygen-rich blood flowing to the brain, kidneys, and other organs.
Restoring blood flow to the organs keeps the patient alive and may prevent long-term damage to the organs. Emergency life support treatment includes:
During and after emergency life support treatment, doctors will try to find out what’s causing the shock. If the reason for the shock is that the heart isn't pumping strongly enough, then the diagnosis is cardiogenic shock.
Treatment for cardiogenic shock will depend on its cause. Doctors may prescribe medicines to:
Medical devices can help the heart pump and improve blood flow. Devices used to treat cardiogenic shock may include:
Sometimes medicines and medical devices aren't enough to treat cardiogenic shock.
Medical procedures and surgery can restore blood flow to the heart and the rest of the body, repair heart damage, and help keep a patient alive while he or she recovers from shock.
Surgery also can improve the chances of long-term survival. Surgery done within
The types of procedures and surgery used to treat underlying causes of cardiogenic shock include:
The best way to prevent cardiogenic shock is to lower your risk for coronary heart disease (CHD) and heart attack. (For more information, go to the National Heart, Lung, and Blood Institute's "Your Guide to a Healthy Heart.")
If you already have CHD, it’s important to get ongoing treatment from a doctor who has experience treating heart problems.
If you have a heart attack, you should get treatment right away to try to prevent cardiogenic shock and other possible complications.
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, the NHLBI sponsored a study to find out whether early treatment to open blocked coronary arteries could reduce in-hospital deaths from cardiogenic shock.
The study results supported such treatment in people younger than 75 who have cardiogenic shock caused by a heart attack.
Many more questions remain about heart diseases and conditions, including cardiogenic shock. The NHLBI continues to support research aimed at learning more about these diseases and conditions.
Research often depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to cardiogenic shock, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.