Cardiogenic Shock

Cardiogenic shock is a state where the heart has been damaged to the point where it is unable to supply enough blood to the organs of the body. As a result of the failure of the heart to pump enough nutrients to the body, blood pressure begins to fall and organs may begin to fail.

While very rare, cardiogenic shock is a serious medical emergency. According to the National Institutes of Health, in the past, almost no one survived cardiogenic shock. These days, over 50 percent survive, due to improved treatments and quicker recognition of symptoms.

Nevertheless, if left ignored and untreated, the outlook is very poor. If you are experiencing any of the symptoms of this condition, contact your doctor immediately.

Cardiogenic shock is most commonly the result of a heart attack. During a heart attack, the flow of blood through the arteries supplying the heart is restricted or blocked completely. This can lead to cardiogenic shock.

Other conditions that may cause cardiogenic shock are:

• Pulmonary embolism (sudden blockage of an artery in the lung)
• Pericardial tamponade (fluid buildup around the heart reducing its filling capacity)
• Sudden valvular regurgitation (damage to the valves allowing the backflow of blood)
• Rupture of the wall of the heart (due to increased pressure)
• Inability of heart muscle to work properly (or at all in some cases)
• Ventricular fibrillation
• Ventricular tachycardia

Drug overdoses can also affect your heart’s ability to pump blood, and lead to a cardiogenic shock.

Risk factors for cardiogenic shock include:

• previous history of myocardial infarction
• plaque buildup in the coronary arteries (arteries supplying blood to the heart)
• long-term valvular disease (disease affecting the valves of the heart)

Symptoms of cardiogenic shock can present very rapidly, and may include all or most of the following:

• Confusion and anxiety due to decreased cerebral perfusion
• Sweating and cold extremities due to decreased blood pressure and cardiac output
• Tachycardia (rapid but weak heart beat)
• Oliguria (low urine output) due to decreased blood flow to the kidneys
• Fatigue due to hyperventilation as the lungs try to correct the worsening acid buildup in the blood
• Fluid in the lungs resulting from the insufficiency of the heart to pump the blood properly
• Coma may result if measures are not taken in time to stop the shock

If you are experiencing any of these symptoms, it is essential to contact a health professional immediately. The sooner the condition is treated, the better the outlook.

If you see someone suffering from a heart attack, or believe you may be suffering a heart attack, get medical help immediately. Early medical attention may be able to prevent cardiogenic shock and decrease damage to the heart. If left untreated, the shock will worsen and can be fatal.

To diagnose cardiogenic shock, your emergency physician will complete a physical exam. The exam will gauge pulse and blood pressure. He or she may request the following tests to confirm diagnosis:

Blood Pressure Measurement

This will show low values in the presence of cardiogenic shock.

Blood Tests

Blood tests can tell if there has been serious damage to heart tissue. They can also tell if there has been a decrease in oxygen values. If the cardiogenic shock was due to myocardial infarction, cardiac enzymes will be raised and oxygen saturation will be lower.

Electrocardiogram (ECG)

This shows the electrical activity of the heart. The test may show arrhythmias such as ventricular tachycardia or ventricular fibrillation that may be cause of the cardiogenic shock. An ECG may also show a quickened pulse.

Echocardiography

This ultrasound imaging of the structure and activity of the heart provides a 2D image showing the flow of blood. It may an immobile part of the heart (as in myocardial infarction) or it may point to a valvular abnormality that shows the backflow of blood.

Swan-Ganz Catheter

This is a pulmonary catheter that is inserted into the heart to show its pumping activity.

To treat cardiogenic shock, your physician must find and treat the cause of the shock. If myocardial infarction is the cause, your doctor may give you oxygen and then insert a catheter into the arteries supplying the heart muscle to remove the obstruction.

If an arrhythmia is the underlying cause, your doctor may try to correct the arrhythmia with electrical shock. Electrical shock is also known as defibrillation or cardioversion. The doctor may also give medications and fluid to improve blood pressure and cardiac output.

Preventing the occurrence of its root causes is the key to preventing cardiogenic shock. This includes hypertension, smoking, obesity, and high levels of cholesterol. For those who have a previous history of heart attack, prevention methods may include medication regimes as directed by their doctors.

Patients with hypertension or previous history of heart attack should keep their blood pressure under control and use medications as directed by their doctors. Obese patients should exercise regularly and try to lose weight. Patients with high cholesterol should lower their intake of fat in their diet. Smokers should try to quit smoking.