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

Shock - cardiogenic

• Chest pain or pressure
• Coma
• Decreased urination
• Fast breathing
• Fast pulse
• Heavy sweating, moist skin
• Lightheadedness
• Loss of alertness and ability to concentrate
• Restlessness, agitation, confusion
• Shortness of breath
• Skin that feels cool to the touch
• Pale skin color or blotchy skin
• Weak (thready) pulse

An examination will show:

• Low blood pressure (usually less than 90 systolic)
• Blood pressure drops 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 lung artery (right heart catheterization). Tests may show that blood is backing up into the lungs and the heart is not pumping properly.

Tests include:

• Cardiac catheterization
• Chest x-ray
• Coronary angiography
• Echocardiogram
• Electrocardiogram
• Nuclear scan of the heart

Other studies may be done to find out why the heart is not working properly.

Lab tests include:

• Arterial blood gas
• Blood chemistry (chem-7, chem-20, electrolytes)
• Cardiac enzymes (troponin, CKMB)
• Complete blood count (CBC)
• Thyroid stimulating hormone (TSH)

Cardiogenic shock is a medical emergency. You will need to stay in the hospital, usually in the Intensive Care Unit. The goal of treatment is to find and treat the cause of shock to save your life.

You may need medicines to increase blood pressure and improve heart function, including:

• Dobutamine
• Dopamine
• Epinephrine
• Levosimendan
• Milrinone
• Norepinephrine

These medicines may help in the short-term. They are not usually used for a long time.

When a heart rhythm disturbance (dysrhythmia) is serious, urgent treatment may be needed to restore a normal heart rhythm. This may include:

• Electrical "shock" therapy (defibrillation or cardioversion)
• Implanting a temporary pacemaker
• Medications given through a vein (intravenous)

You may also receive:

• Pain medicine
• Oxygen
• Fluids, blood, and blood products through a vein (IV)

Other treatments for shock may include:

• Cardiac catheterization with coronary angioplasty and stenting
• Heart monitoring to guide treatment
• Heart surgery (coronary artery bypass surgery, heart valve replacement, left ventricular assist device)
• Intra-aortic balloon counterpulsation (IABP) to help the heart work better
• Pacemaker
• Ventricular assist device

In the past, the death rate from cardiogenic shock ranged from 80 - 90%. In more recent studies, this rate has decreased to 50 - 75%.

When cardiogenic shock is not treated, the outlook is poor.

• Brain damage
• Kidney damage
• Liver damage

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of cardiogenic shock. Cardiogenic shock is a medical emergency.

You may reduce the risk of developing cardiogenic shock by:

• Quickly treating its cause (such as heart attack or heart valve problem)
• Preventing and treating the risk factors for heart disease, such as diabetes, high blood pressure, high cholesterol and triglycerides, or tobacco use

Gheorghiade M, Filippatos GS, Felker GM. Diagnosis and management of acute failure syndromes. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders; 2011:chap 27.

Hollenberg S. Cardiogenic shock. In: Goldman L, Schafer AI,eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap107.