Cardiogenic Shock

Cardiogenic shock is a life-threatening condition that occurs when the heart is unable to pump enough blood to meet the body’s needs. It is a severe form of heart failure and requires immediate medical attention.

 

Types

Cardiogenic shock can be broadly categorized into two types based on the underlying cause:

  • Acute myocardial infarction (AMI) cardiogenic shock: This type occurs as a complication of a heart attack when a significant portion of the heart muscle is damaged, leading to impaired pumping function.
  • Non-AMI cardiogenic shock: This type can be caused by various conditions other than a heart attack, such as severe heart failure, myocarditis (inflammation of the heart muscle), arrhythmias, or structural heart defects.

 

Causes

The primary cause of cardiogenic shock is a significant decrease in the heart’s pumping ability. This can be due to various factors, including:

  • Myocardial infarction (heart attack): The most common cause of cardiogenic shock is a heart attack that damages a large area of the heart muscle.
  • Severe heart failure: When the heart becomes weak and unable to effectively pump blood, it can lead to cardiogenic shock.
  • Cardiac arrhythmias: Abnormal heart rhythms, such as ventricular fibrillation or sustained ventricular tachycardia, can cause cardiogenic shock.
  • Structural heart defects: Conditions like severe valve disease, ventricular septal defect, or acute rupture of the heart muscle can impair heart function and lead to shock.
  • After heart surgery, including valve, bypass, or heart pump placement
  • Severely damage to the heart valves, especially the aortic valve
  • Massive blood clots in the lung vessels
  • Acute viral infections of the heart

 

Symptoms

The symptoms of cardiogenic shock may include:

  • Severe shortness of breath or difficulty breathing
  • Rapid and shallow breathing
  • Cold and clammy skin, while sweating
  • Rapid heartbeat (tachycardia)
  • Nausea and vomiting
  • Weak pulse
  • Low blood pressure
  • Confusion or altered mental status
  • Profound fatigue or weakness
  • Chest pain or discomfort

 

Risk factors

Several factors can increase the risk of developing cardiogenic shock, including:

  • History of heart disease or heart attack
  • Older age
  • Diabetes
  • High blood pressure
  • Previous heart failure
  • Smoking
  • Obesity
  • Chronic kidney disease

 

Diagnosis

Diagnosing cardiogenic shock involves a combination of clinical evaluation, medical history review, and diagnostic tests, including:

  • Physical examination: The physician will assess vital signs, listen to the heart and lungs, and check for signs of low blood pressure or poor organ perfusion.
  • Electrocardiogram (ECG): This test records the electrical activity of the heart and can help identify abnormal rhythms or signs of a heart attack.
  • Blood tests: These tests can assess cardiac enzymes, troponin levels, and blood gas analysis to evaluate heart function and tissue damage.
  • Echocardiogram: This ultrasound test provides detailed images of the heart to assess its structure, function, and pumping ability.
  • Cardiac catheterization: In most cases, a cardiac catheter may be used to measure pressures within the heart chambers and blood vessels.

 

Treatment

Cardiogenic shock is a medical emergency that requires prompt treatment in an intensive care setting. Our team aims to stop the detrimental effects of the low blood pressure on the different organs of the body, while at the same time attempt to improve the heart function and reverse the cause of shock. Treatment options may include:

  • Medications: Inotropic medications may be given to improve the heart’s pumping function. Other medications, such as vasopressors, may be used to increase blood pressure.
  • Oxygen therapy: Supplemental oxygen can help improve oxygenation and relieve breathing difficulties.
  • Mechanical support: Devices like an intra-aortic balloon pump (IABP), Impella, VA-ECMO, or ventricular assist devices (VADs) may be used to support heart function.
  • Revascularization: If the cause of cardiogenic shock is a heart attack, emergency procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) may be performed to restore blood flow to the heart.
  • Fluid management: Intravenous fluids may be given cautiously to maintain adequate blood volume and blood pressure.
  • Treatment of underlying causes: If the shock is caused by a specific condition, such as arrhythmias or structural heart defects, appropriate treatment measures will be taken.
  • In some cases when the heart is not recovering, we offer heart transplantation.

 

When to consult a physician

Cardiogenic shock is a medical emergency, and you should seek immediate medical attention if you experience symptoms such as severe shortness of breath, rapid heartbeat, and low blood pressure. If you have a known heart condition, it is essential to monitor your symptoms closely and seek medical help if you notice any significant changes or worsening of symptoms.