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How Is Cardiogenic Shock Treated?

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

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:

  • Giving the patient extra oxygen to breathe so that more oxygen reaches the lungs, the heart, and the rest of the body.
  • Providing breathing support if needed. A ventilator might be used to protect the airway and provide the patient with extra oxygen. A ventilator is a machine that supports breathing.
  • Giving the patient fluids, including blood and blood products, through a needle inserted in a vein (when the shock is due to blood loss). This can help get more blood to major organs and the rest of the body. This treatment usually isn’t used for cardiogenic shock because the heart can't pump the blood that's already in the body. Also, too much fluid is in the lungs, making it hard to breathe.

Medicines

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:

  • Prevent blood clots from forming
  • Increase the force with which the heart muscle contracts
  • Treat a heart attack

Medical Devices

Medical devices can help the heart pump and improve blood flow. Devices used to treat cardiogenic shock may include:

  • An intra-aortic balloon pump. This device is placed in the aorta, the main blood vessel that carries blood from the heart to the body. A balloon at the tip of the device is inflated and deflated in a rhythm that matches the heart’s pumping rhythm. This allows the weakened heart muscle to pump as much blood as it can, which helps get more blood to vital organs, such as the brain and kidneys.
  • A left ventricular assist device (LVAD). This device is a battery-operated pump that takes over part of the heart’s pumping action. An LVAD helps the heart pump blood to the body. This device may be used if damage to the left ventricle, the heart’s main pumping chamber, is causing shock.

Medical Procedures and Surgery

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 6 hours of the onset of shock symptoms has the greatest chance of improving survival.

The types of procedures and surgery used to treat underlying causes of cardiogenic shock include:

  • Angioplasty (AN-jee-oh-plas-tee) and stents. Angioplasty is a procedure used to open narrowed or blocked coronary (heart) arteries and treat an ongoing heart attack. A stent is a small mesh tube that's placed in a coronary artery during angioplasty to help keep it open.
  • Coronary artery bypass grafting. For this surgery, arteries or veins from other parts of the body are used to bypass (that is, go around) narrowed coronary arteries. This creates a new passage for oxygen-rich blood to reach the heart.
  • Surgery to repair damaged heart valves.
  • Surgery to repair a break in the wall that separates the heart’s chambers. This break is called a septal rupture.
  • Heart transplant. This type of surgery rarely is done during an emergency situation like cardiogenic shock because of other available options. Also, doctors need to do very careful testing to make sure a patient will benefit from a heart transplant and to find a matching heart from a donor. Still, in some cases, doctors may recommend a transplant if they feel it's the best way to improve a patient's chances of long-term survival.
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July 1, 2011