Cardiogenic Shock Treatment

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Cardiogenic shock is life-threatening, but it is treatable if diagnosed and treated quickly.

At the hospital, you may need medicines and a procedure to restore blood flow to your heart. You may also need other emergency treatment, including temporary medical devices, to stabilize or support you until you receive a permanent device or have a heart transplant.

People who have severe organ damage may not be expected to survive after cardiogenic shock. In that case, palliative care or hospice care may help them have a better quality of life with fewer symptoms in the short term.

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.

• Medicines to restore a regular heartbeat are called anti-arrhythmia medicines.
• Blood thinners or antiplatelet medicines can dissolve blood clots and reduce  platelets  that may be blocking the coronary arteries.
• Medicines that increase blood pressure and blood flow out of the heart are called vasopressors and inotropes, including norepinephrine and dobutamine.

Some medical procedures may be done right away to restore blood flow within your heart and throughout your body, preventing organ damage.

Coronary artery bypass grafting (CABG) 

Coronary artery bypass grafting (CABG pronounced like “cabbage”), sometimes called coronary artery bypass surgery or just bypass surgery, is a procedure to improve poor blood flow to the heart muscle. The surgery creates new paths for blood to flow to the heart when the arteries that supply blood to the heart itself, called coronary arteries, are narrowed or blocked. The surgeon attaches a healthy piece of blood vessel from another part of the body on either side of a coronary artery blockage to bypass it. This surgery may lower the risk of serious complications for people who have obstructive coronary artery disease, which can cause chest pain or even heart failure. It may also be used in an emergency, such as a severe heart attack, to restore blood flow. 

Percutaneous cardiac intervention

Percutaneous coronary intervention (PCI), also called coronary angioplasty, is a nonsurgical procedure that improves blood flow to your heart. Doctors use PCI to open blood vessels supplying the heart that are narrowed or blocked by plaque buildup. PCI requires cardiac catheterization.

A cardiologist, the doctor who specializes in the heart, performs PCI in a hospital cardiac catheterization laboratory. Live X-rays help your doctor guide a catheter through your blood vessels into your heart, where special contrast dye is injected to highlight any blockage. To open a blocked artery, your doctor will insert another catheter over a guidewire and inflate a balloon at the tip of that catheter. Your doctor may also put a small mesh tube called a stent in your artery to help keep the artery open.

You may develop a bruise and soreness where the catheters were inserted. It also is common to have discomfort or bleeding where the catheters were inserted. You will recover in a special unit of the hospital for a few hours or overnight. You will get instructions on how much activity you can do and what medicines to take. You will need a ride home because of the medicines and anesthesia you received. Your doctor will check your progress during a follow-up visit. If a stent is implanted, you will have to take certain anticlotting medicines exactly as prescribed, usually for at least 3 to 12 months.

Serious complications during a PCI procedure or as you are recovering after one are rare, but they can happen. This might include:

• Bleeding
• Blood vessel damage
• Treatable allergic reaction to the contrast dye
• Need for emergency coronary artery bypass grafting during the procedure
• Arrhythmias, or irregular heartbeats
• Damaged arteries
• Kidney damage
• Heart attack
• Stroke
• Blood clots

Sometimes chest pain can occur during PCI because the balloon briefly blocks blood supply to the heart. Restenosis, when tissue regrows where the artery was treated, may occur in the months after PCI. This may cause the artery to become narrow or blocked again. The risk of complications from this procedure is higher if you are older, have chronic kidney disease, are experiencing heart failure at the time of the procedure, or have extensive heart disease and more than one blockage in your coronary arteries.

You may need a medical device to aid, bring back, or maintain blood flow. This can help prevent organ damage from cardiogenic shock. Sometimes temporary devices are used to support people who are waiting for surgery to receive a permanent support device or a heart transplant.

• An extracorporeal membrane oxygenation (ECMO) device temporarily replaces the function of the heart and lungs by circulating the blood and supplying oxygen to the body’s organs. It is connected to the patient through tubes placed in the large blood vessels near the base of the neck. The device draws blood from the right side of the heart and pumps it through a smaller device that works like an artificial lung to add oxygen. Then, the blood is returned to the left side of the heart so the oxygen-rich blood can be pumped throughout the body.
• An intra-aortic balloon pump (IABP) may improve survival when used with ECMO device. An IABP may also be used for a short time in people who have cardiogenic shock from heart failure until another more permanent procedure can be done. An IABP helps the heart muscle pump as much blood as it can to the body, but the heart uses less energy to do it. 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 the heart until it recovers or while waiting for a heart transplant. A PCAD can help the heart work better if the patient is not eligible for a heart transplant. Risks include blood clots, bleeding, infection, device malfunction, and right-sided heart failure if a left-sided VAD was used.

• Continuous kidney dialysis filters waste out of the blood if the kidneys are damaged.
• Fluids given through an intravenous (IV) line inserted in one of the blood vessels can maintain normal blood volumes.
• Mechanical breathing support, such as a ventilator, can protect the airway and provide extra oxygen.
• Oxygen therapy can help more oxygen reach the lungs, the heart, and the rest of the body.