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Cardiogenic shock
Definition
Cardiogenic shock is a disease state where the heart is damaged enough that it is unable to supply sufficient blood to the body.
Alternative Names
Shock - cardiogenic
Causes
Shock occurs whenever the heart is unable to pump enough blood for the needs of the body. Cardiogenic shock can be caused by disorders of the heart muscle, the valves, or the heart's electrical conduction system.
Some related disorders include heart attack, heart failure, cardiomyopathy, rupture of the heart, abnormal heart rhythms, and heart valve disorders (especially leaky valves).
Symptoms
Exams and Tests
An examination will reveal low blood pressure (less than 90 systolic), and the blood pressure may drop more than 10 points when the patient stands up after lying down (orthostatic hypotension). The pulse may be weak or absent.
To diagnose cardiogenic shock, a catheter (tube) may be placed in the pulmonary artery. Measurements often indicate that blood is backing up into the lungs and that the heart has poor pumping function.
Tests used in patients with cardiogenic shock include:
Other tests may be recommended to determine the cause of the heart's failure to function properly.
Laboratory tests include:
Treatment
Cardiogenic shock is a medical emergency. Treatment requires hospitalization. The goal of treatment is to save the patient's life and treat the underlying cause of shock.
Dopamine, dobutamine, epinephrine, norepinephrine, amrinone, or other medications may be required to increase blood pressure and heart functioning. Pain medicine may be given if necessary. Bed rest is recommended to reduce demands on the heart.
Oxygen reduces the workload of the heart by reducing tissue demands for blood flow.
Intravenous fluids, including blood and blood products, may be given if indicated.
Other treatments of shock may include:
- Cardiac pacing (pacemaker)
- Heart monitoring, including hemodynamic monitoring, to guide treatment
- Intra-aortic balloon counterpulsation (IABP) to improve heart and blood vessel (cardiovascular) function
Note: Surgical repair of the cause should be performed if it is feasible. Balloon angioplasty (PTCA) may be an alternative to surgery in some cases.
Outlook (Prognosis)
Approximately 80% of cases of cardiogenic shock are fatal, even with treatment.
Possible Complications
When to Contact a Medical Professional
Go to the emergency room or call the local emergency number (such as 911) if symptoms are present. Cardiogenic shock is a medical emergency.
Prevention
The risk may be reduced by prompt, aggressive treatment of related disorders.
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