Cardiology Health Channel

Definition

Cardiogenic shock is a state in which the heart has been damaged so much that it is unable to supply enough blood to the organs of the body.

Alternative Names

Shock - cardiogenic

Causes, incidence, and risk factors

Shock occurs whenever the heart is unable to pump as much blood as the body needs.

The most common causes are serious heart complications. Many of these occur during or after a heart attack (myocardial infarction). These complications include:

• Dangerous heart rhythms, such as ventricular tachycardia, ventricular fibrillation, or supraventricular tachycardia
• Very slow heart rhythm (bradycardia) or heart conduction block
• Tear or rupture of the wall (septum) between the left and right ventricle
• Tear or rupture of the muscles or tendons that support the heart valves, especially the mitral valve
• A large section of heart muscle that no longer moves well or does not move at all
• Rupture of the heart muscle due to damage from the heart attack

Symptoms

• Profuse sweating, moist skin
• Rapid breathing
• Rapid pulse
• Restlessness, agitation, confusion
• Skin that feels cool to the touch
• Pale skin color or blotchy (mottled) skin
• Weak (thready) pulse
• Decreased mental status
  • Loss of ability to concentrate
  • Loss of alertness
• Coma

Signs and tests

An examination will reveal:

• Low blood pressure (less than 90 systolic)
• Blood pressure may drop more than 10 points when you stand up after lying down (orthostatic hypotension)
• Weak (thready) pulse

To diagnose cardiogenic shock, a catheter (tube) may be placed in the pulmonary artery (right heart catheterization). Measurements often indicate that blood is backing up into the lungs and the heart is not pumping properly.

Tests include:

• Coronary angiography
• Echocardiogram
• Electrocardiogram
• Nuclear scans

Other tests may be recommended to determine why the heart is not functioning properly.

Laboratory tests include:

• Arterial blood gas
• Blood chemistry (chem-7, chem-20, electrolytes, cardiac enzymes)
• CBC

Treatment

Cardiogenic shock is a medical emergency. Treatment requires hospitalization. The goal of treatment is to save your life and treat the cause of shock.

Medications may be needed to increase blood pressure and heart function, including:

• Dopamine
• Dobutamine
• Epinephrine
• Norepinephrine

When an arrhythmia is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include:

• Electrical "shock" therapy (defibrillation o

  ...