A heart attack is the most common cause because it can damage the heart’s structure in different ways. Less often, a problem elsewhere in the body blocks blood flow coming into or out of the heart and leads to cardiogenic shock. For more information on the structure of the heart and how it works, visit our How the Heart Works Health Topic.
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:
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.
At a molecular level, inflammation may cause cardiogenic shock. The low blood pressure caused by cardiogenic shock can also trigger a massive inflammatory response, leading to a vicious cycle and lowering the chance of survival.
If a heart attack or other problem damages the heart, an inflammatory response happens throughout the body. Cells release substances called cytokines, which then stimulate high levels of a gas called nitric oxide. Nitric oxide causes blood vessels throughout the body to relax and widen, leading to an even greater drop in blood pressure. The body also reacts in an opposite way by releasing other substances that make the blood vessels narrow. This can further reduce the flow of oxygen-rich blood to the vital organs and increase the risk of organ failure. When the heart itself does not get enough oxygen, its ability to pump blood weakens and the chance of survival drops.
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?
Shock can occur when your body does not get enough oxygen-rich blood for any reason and may lead to tissue damage and organ failure. Cardiogenic shock is usually caused by poor pumping function of the heart. Other causes of shock include:
You may have an increased risk of cardiogenic shock because of your age, any cardiovascular or other medical conditions you have, medical procedures, your race or ethnicity, and your sex.
Existing cardiovascular diseases can increase your risk of cardiogenic shock. These include:
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.
Currently there are no routine screening tests for cardiogenic shock. The main cause of cardiogenic shock is a heart attack, which is a complication of ischemic heart disease. You can reduce your risk for cardiogenic shock by adopting heart-healthy lifestyle changes to help prevent ischemic heart disease.
If you already have ischemic heart disease or another heart condition, follow your doctor’s instructions about taking care of your health, getting regular check-ups, and taking medicines.
Signs and symptoms of cardiogenic shock vary depending on how quickly and how low your blood pressure drops. Cardiogenic shock may start with mild symptoms, such as feeling confused or breathing rapidly, or a person may have no symptoms and then suddenly lose consciousness. Cardiogenic shock is a life-threatening emergency. Complications may include organ damage or organ failure.
The most common signs of cardiogenic shock are:
Other signs and symptoms of cardiogenic shock may include:
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.
As blood pressure drops during cardiogenic shock, the body tries to compensate by limiting blood flow to the extremities—the hands and feet—causing them to cool down. As blood flow to the brain drops, the person may become confused or lose consciousness. The kidneys may shut down, producing less urine. Reduced blood flow in the lungs may lead to fluid buildup in the lungs, making it hard to breathe.
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.
Your doctor will check your medical history, perform a physical exam, and do tests and procedures to diagnose cardiogenic shock. Tests are usually done after you have been admitted to a hospital for a possible heart attack or symptoms of shock. If the reason for the shock is that the heart is not pumping strongly enough, then the diagnosis is cardiogenic shock.
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:
Your doctor may order the following tests and procedures to diagnose cardiogenic shock.
Cardiogenic shock is life-threatening and requires rapid diagnosis and identification of the cause, and emergency medical treatment. Treatments include medicines, heart procedures, and medical devices to support or restore blood flow in the body and prevent organ damage.
Because cardiogenic shock is a serious medical condition affecting multiple body organs, a team of medical specialists usually provides care. Some medical devices may be used temporarily to stabilize or support you until a permanent device can be implanted or until a heart transplant can be performed.
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:
The following medical procedures may be done right away to restore blood flow within your heart and throughout your body to prevent organ damage.
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.
Additional emergency treatments may include:
Cardiogenic shock is life-threatening, but it is treatable. As you recover from cardiogenic shock, it is important to follow your treatment plan and adopt healthy lifestyle changes to prevent another event.
You also may need follow-up treatment or support for implanted devices or complications of cardiogenic shock, including organ failure. If cardiogenic shock led to heart failure, your doctor may recommend a heart transplant.
Follow your doctor’s instructions about your treatment plan.
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.
Because cardiogenic shock is usually a serious complication of ischemic heart disease, your doctor may recommend a heart-healthy lifestyle, which includes:
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.
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:
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.
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.
Learn about the following ways the NHLBI continues to translate current research into improved health for people who may have an increased risk of cardiogenic shock. Research on this topic is part of the NHLBI’s broader commitment to advancing heart and vascular disease scientific discovery.
Learn about some of the pioneering research contributions we have made over the years that have improved clinical care.
In support of our mission, we are committed to advancing research into complications of ischemic heart disease, including cardiogenic shock, in part through the following ways.
Learn about exciting research areas the NHLBI is exploring about ischemic heart disease and complications of the disease.
We lead or sponsor many studies relevant to cardiogenic shock. See if you or someone you know is eligible to participate in our clinical trials.
After reading our Cardiogenic Shock Health Topic, you may be interested in additional information found in the following resources.