Cardiogenic Shock

A heart attack is the most common cause of cardiogenic shock. Cardiogenic shock usually develops very quickly when it follows a heart attack.

Heart attacks can damage the heart’s muscles and tissues and cause serious heart conditions that may lead to cardiogenic shock. These include:

• Papillary muscle infarction or rupture. The muscles that help anchor the heart valves stop working or break when a heart attack cuts off their blood supply. If this happens, blood does not flow correctly between the heart’s chambers. The muscle infarction or rupture prevents the heart from pumping properly.
• Ventricular septal rupture. Damage from a heart attack can cause the wall that separates the ventricles, which are the heart’s two lower chambers, to break down. Without the wall to separate them, the ventricles cannot pump properly.

Other heart conditions, such as heart failure or arrhythmia, can reduce the heart’s ability to deliver oxygen-rich blood to your organs, leading to cardiogenic shock. Injuries that damage the heart can also cause cardiogenic shock.

Inflammation plays an important role in cardiogenic shock.

Cardiogenic shock can be caused by problems outside the heart, including fluid buildup in the chest causing cardiac tamponade, internal bleeding or blood loss, or pulmonary embolism, a type of venous thromboembolism. Trauma or injury to the chest can damage the heart so that it no longer pumps blood effectively. For example, injuries that bruise or put pressure on the heart can cause cardiogenic shock.

Rarely, some medicines can cause cardiogenic shock if you take a dose that is too high or if your heart is not working well after a heart attack or other heart problem. Examples include heart medicines such as beta blockers or calcium channel blockers to treat high blood pressure. It is rare for medicines to cause cardiogenic shock, and you can lower your risk by taking the right doses of medicines at the right time.

Very rarely, a heart procedure, such as cardiac catheterization, may injure the heart itself or cause arrhythmia, leading to cardiogenic shock.

Cardiogenic shock usually is caused by heart problems. What causes other types of shock?

• Treatment will discuss emergency life support that first responders or doctors provide for cardiogenic shock.

People who are 75 or older are at greater risk for cardiogenic shock. They are also less likely to receive emergency procedures to restore blood flow.

Learn the signs and symptoms of cardiogenic shock and ways to lower your risk for this condition.

Existing cardiovascular diseases can increase your risk of cardiogenic shock. These include:

• Atherosclerosis, which is plaque buildup in the arteries
• Cardiomyopathy, including Takotsubo cardiomyopathy, also called broken heart syndrome
• Conduction disorders
• Heart attack
• Heart failure
• High blood cholesterol
• High blood pressure
• High blood triglycerides
• Heart inflammation
• Heart valve diseases
• Ischemic heart disease

Other medical conditions that can raise your risk for cardiogenic shock include:

• Diabetes and prediabetes
• Overweight and obesity
• Pneumothorax, a type of pleural disorder that can lead to a collapsed lung
• Sepsis

You may have a greater risk for cardiogenic shock if you have had coronary artery bypass grafting (CABG) in the past.

Asian Americans and Pacific Islanders have a higher risk of cardiogenic shock than other racial or ethnic groups.

Hispanics and African Americans are less likely than whites to receive emergency lifesaving treatment to restore blood flow when they have cardiogenic shock.

Learn more about prompt treatments for cardiogenic shock and ways to lower your risk for this condition.

Cardiogenic shock is more common in men than women. However, women are less likely than men to receive emergency treatment to restore blood flow when they have cardiogenic shock.

Learn more about prompt treatments for cardiogenic shock and ways to lower your risk for this condition.

• Diagnosis will discuss tests and procedures that doctors may use to diagnose cardiogenic shock.
• Life After will explain what doctors may recommend to help you recover from cardiogenic shock and prevent it from recurring.
• Research for Your Health will explain how we are using current research and advancing research to prevent cardiogenic shock.

The most common signs of cardiogenic shock are:

• Low blood pressure, which can make you feel dizzy, confused and nauseous
• Weak or irregular pulse

Other signs and symptoms of cardiogenic shock may include:

• Breathing problems, including rapid breathing and severe shortness of breath
• Bulging of large veins in the neck
• Clammy skin
• Cold hands and feet
• Loss of consciousness
• Swelling of feet
• Urinating much less than usual or not at all

Any of these alone is not likely to be a sign or symptom of cardiogenic 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.

Many symptoms of cardiogenic shock develop because the heart does not deliver enough blood to the body’s tissues and organs.

In severe cardiogenic shock, the body’s organs do not get enough oxygen-rich blood. This can cause temporary or permanent damage to the vital organs of your body.

• Brain injury
• Kidney failure
• Liver damage

• Diagnosis will explain tests and procedures used to detect signs of cardiogenic shock.
• Treatment will explain treatment-related complications or side effects.

Your doctor will ask you or your family members about your medical history, especially any symptoms of a heart attack before you became ill. Your doctor will also want to know about any medicines you are taking.

During a physical exam your doctor may:

• Check your hands and feet for cold temperature or swelling.
• Check your pulse. If your heart cannot pump strongly, your pulse may be weak and rapid. If cardiogenic shock was caused by doses of heart medicines that were too high, the heart rate may be normal or slow.
• Listen to your heart and lungs with a stethoscope for unusual sounds or heart rhythms.
• Measure how much you urinate to check how well your kidneys are working.
• Measure your blood pressure. Low blood pressure that does not return to normal on its own is a sign of cardiogenic shock.

Your doctor may order the following tests and procedures to diagnose cardiogenic shock.

• Blood gas tests to check the amounts of oxygen and carbon dioxide in the veins and arteries.
• Blood tests to check the function of the heart, liver, and kidneys and look for increased lactate levels.
• Cardiac CT scan to create a three-dimensional image of the heart to detect or evaluate heart disease or problems with heart function and its valves.
• Chest X-rays to examine the heart and lungs.
• Coronary angiography to look at the flow of blood through the heart and blood vessels.
• Echocardiography to assess blood flow in and out of the heart and look for heart problems.
• Electrocardiogram (EKG or ECG) to identify abnormal heart rhythms and confirm whether a heart attack has occurred.

• Return to Risk Factors to review lifestyle and other factors that increase the risk of developing cardiogenic shock and its complications.
• Return to Screening and Prevention to learn about heart-healthy lifestyle habits that may reduce the risk for cardiogenic shock.
• Return to Signs, Symptoms, and Complications to review common signs and symptoms of cardiogenic shock.

Medicine can help increase blood flow and protect against organ damage. Some medicines treat the underlying cause of cardiogenic shock, which is usually a heart attack. These medicines include:

• Anti-arrhythmia medicines to restore a regular heartbeat.
• Blood thinners or antiplatelet medicines to dissolve blood clots and reduce platelets that may be blocking the coronary arteries.
• Vasopressors and inotropes, such as norepinephrine and dobutamine, to increase blood pressure and blood flow out of the heart.

The following medical procedures may be done right away to restore blood flow within your heart and throughout your body to prevent organ damage.

• Percutaneous cardiac intervention (PCI) to open coronary arteries that are narrowed or blocked by the buildup of plaque. A small mesh tube called a stent may be implanted after PCI to prevent an artery from narrowing again. Your doctor may repeat PCI later if any other coronary arteries are affected by plaque.
• Coronary artery bypass grafting (CABG) to improve blood flow to the heart. This procedure is usually done as soon as possible after a diagnosis of cardiogenic shock.

You may need a medical device to aid, restore, or maintain blood flow, which may prevent organ damage from cardiogenic shock. Temporary devices sometimes support people who are waiting for surgery to implant a permanent device or for a heart transplant.

• Extracorporeal membrane oxygenation (ECMO) circulates the blood and supplies oxygen to the body’s organs through a heart-lung machine outside of the body. For ECMO devices, tubes connect to the large blood vessels near the base of the neck. The device draws blood from the right side of the heart, pumps it through the oxygenator, and then returns it to the left side of the heart so the oxygen-rich blood can be delivered throughout the body.
• An intra-aortic balloon pump (IABP) is no longer recommended to be used alone in cardiogenic shock, but it may improve survival when used along with ECMO. An IABP may also be used temporarily for people who have cardiogenic shock due to heart failure until another procedure can be done. An IABP helps the weakened heart muscle to pump as much blood as it can to vital organs. The IABP is placed in the aorta, and a balloon at the tip of the device inflates and deflates to match the heart’s pumping rhythm.
• Percutaneous circulatory assist devices (PCADs), including ventricular assist devices (VADs), can help support your heart until it recovers or while you are waiting for a heart transplant. A PCAD can help your heart work better if you are not eligible for a heart transplant. Risks include blood clots, bleeding, infection, device malfunction, and right-sided heart failure if a left VAD was used.

Additional emergency treatments may include:

• Continuous kidney dialysis to filter wastes out of the blood if the kidneys were damaged.
• Fluids given through an intravenous (IV) line inserted in one of your blood vessels to maintain normal blood volumes.
• Mechanical breathing support, such as a ventilator to protect the airway and provide extra oxygen.
• Oxygen therapy so that more oxygen reaches the lungs, the heart, and the rest of the body.

• Research for Your Health will explain how we are using current research and advancing research to treat people who have cardiogenic shock and other complications of ischemic heart disease.
• Participate in NHLBI Clinical Trials discusses our open and enrolling clinical studies that are investigating treatments and diagnostic procedures that may help cardiogenic shock.
• Life After will explain what your doctor may recommend including life-long lifestyle changes, medical care, and follow-up to prevent your condition from recurring, getting worse, or causing complications.

Follow your doctor’s instructions about your treatment plan.

• Get regular medical care. Ask your doctor how often you need to schedule visits for follow-up care.
• Take steps to prevent infection if you had a medical procedure or surgery. It is important to practice good hygiene and to properly clean and care for surgical incisions.
• Take your medicines as your doctor prescribes. Do not change the amount of your medicine or skip a dose unless your doctor tells you to.
• Tell your doctor if you have any new symptoms, if your symptoms worsen, or if you have problems with other medical conditions that may increase your risk for heart events.

Return to Treatment to review possible treatment options for cardiogenic shock.

Your doctor may recommend regular follow-up visits to monitor your condition and any medical device that supports your health after cardiogenic shock.

• If you have an implanted VAD or another type of medical device to help your heart work better, your doctor will check to make sure that the device is working properly. You will be given instructions on what to do if the device gives a warning that it is not working correctly.
• If your heart does not respond well enough to other treatments, your doctor may recommend a heart transplant. A total artificial heart may be an option for patients who had cardiogenic shock affecting both the left and right ventricles of the heart as they wait for a heart transplant. While you wait for a donor heart, you will need to follow your treatment plan carefully.

Because cardiogenic shock is usually a serious complication of ischemic heart disease, your doctor may recommend a heart-healthy lifestyle, which includes:

• Heart-healthy eating, such as the DASH (Dietary Approaches to Stop Hypertension) eating plan. A heart-healthy eating plan includes fruits, vegetables, and whole grains and limits saturated fats, trans fats, sodium, added sugars, and alcohol.
• Being physically active. Routine physical activity can help manage ischemic heart disease risk factors, such as high blood cholesterol, high blood pressure, or overweight and obesity.
• Aiming for a healthy weight. Losing just 3 percent to 5 percent of your current weight can help you manage some ischemic heart disease risk factors, such as high blood cholesterol and diabetes. Greater amounts of weight loss can also improve blood pressure readings.
• Managing stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.
• Quitting smoking. Visit Smoking and Your Heart and the National Heart, Lung, and Blood Institute’s Your Guide to a Healthy Heart. Although these resources focus on heart health, they include basic information about how to quit smoking. For free help and support to quit smoking, you can call the National Cancer Institute’s Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).

If your cardiogenic shock was a complication of ischemic heart disease, you may be referred for exercise-based cardiac rehabilitation, to manage symptoms and reduce the chances of future problems. Studies have shown that exercise-based cardiac rehabilitation reduces the risk of hospitalization and cardiovascular death. Many people who have participated in cardiac rehab also report better quality of life.

If you had cardiogenic shock following a heart attack, your doctor will work with you to manage medical conditions that can raise your risk for heart problems and complications.

• If you have diabetes you will need to check your blood sugar and keep taking any prescribed medicines.
• You may be given a statin to lower your LDL cholesterol.
• Your doctor may recommend aspirin to prevent a repeat heart attack. Low-dose aspirin may help prevent blood clots and reduce the risk for repeat heart attacks and other complications of ischemic heart disease for some people, including those who have diabetes.

Living with a heart condition may cause fear, anxiety, depression, and stress. Talk with your health care team about how you feel. Your doctor may recommend you take steps that include:

• Talking to a professional counselor. Your doctor may recommend medicines or other treatments that can improve your quality of life.
• Joining a patient support group. This may help you adjust to life after cardiogenic shock. You can find out how other people who have the same symptoms as yours have coped with them. Your doctor may be able to recommend local support groups, or you can check with an area medical center.
• Seeking support from family and friends. Letting your loved ones know how you feel and what they can do to help you can help relieve stress and anxiety.

A lack of oxygen-rich blood to the body can lead to problems throughout the body, including the heart, brain, and kidneys. Learn the warning signs of repeat heart attacks, stroke, and other complications of ischemic heart disease. Ischemic heart disease can lead to cardiogenic shock.

• Brain injury. Brain cells can begin to die within a few minutes after oxygen supply has been reduced or cut off. Symptoms include a short attention span, poor judgment, memory loss, and a decrease in physical coordination. Talk with your doctor about what to do if you or a loved one who had cardiogenic shock experiences the symptoms of brain injury.
• Heart attack. Signs and symptoms of heart attack include mild or severe chest pain or discomfort in the center of the chest or upper abdomen that lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, heartburn, or indigestion. There may also be pain down the left arm. Women may also have chest pain and pain down the left arm, but they are more likely to have less typical symptoms, such as shortness of breath, nausea, vomiting, unusual tiredness, and pain in the back, shoulders, or jaw.
• Kidney failure. Learn about the symptoms of kidney disease, which can begin so slowly that you may not notice the symptoms right away. Talk with your doctor about whether you need regular testing of your kidney function and early treatments.
• Liver damage. When the liver does not receive enough oxygen from the blood, the result can be a condition called hypoxic hepatitis. Hypoxic hepatitis may go away when the cause of the cardiogenic shock is treated. Talk with your doctor about what tests you may need to monitor liver function and any special care or dietary changes you may need to care for your liver. Rarely, the liver may stop working after cardiogenic shock; this is called liver failure.
• Stroke. If you think someone may be having a stroke, act F.A.S.T. and perform the following simple test.
  F—Face: Ask the person to smile. Does one side of the face droop?
  A—Arms: Ask the person to raise both arms. Does one arm drift downward?
  S—Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?
  T—Time: If you observe any of these signs, call 9-1-1 immediately. Early treatment is essential.

If a pulmonary embolism, a type of venous thromboembolism, caused your cardiogenic shock, your doctor will recommend follow-up treatment to break up or stabilize the clots and help blood flow return to normal. To prevent a repeat event, your doctor may adjust your medicine or treatment plan.