Cardiogenic shock is a complex condition that occurs when the heart cannot pump enough blood for the body’s needs. The condition is a medical emergency and is often fatal without immediate treatment. Cardiogenic shock most often occurs following a severe heart attack; the event damages and weakens the heart. Around seven percent of people who have a heart attack go into cardiogenic shock. The condition is the leading cause of death from heart attacks.
What is Shock?
People can experience many types of shock, a general term that refers to the state where integral organs do not receive enough blood and oxygen. States of shock are almost always dangerous, regardless of their cause or effect. Most forms also cause severely low blood pressure and heart rate. Cardiogenic shock specifically refers to the state of shock resulting from and affecting the heart.
Symptoms of Cardiogenic Shock
There are many possible symptoms of cardiogenic shock because the entire body requires the oxygenated blood pumped from the heart. Without it, systems begin to fail. Some of the signs and symptoms of cardiogenic shock include:
Shortness of breath
Rapid heart rate or tachycardia
Cold extremities, mainly hands and feet
Urinating less often or not at all
Urine with less volume
Low blood pressure
In addition, some people undergo changes in their mental state, including increased agitation, restlessness, and general confusion.
Symptoms of a Heart Attack
Many heart attacks feature a pressure, fullness, or squeezing pain in the center of the chest, often lasting for several minutes. Other symptoms include sweating, shortness of breath, lightheadedness, and dizziness. Some people experience nausea and vomiting. One of the key signs of a heart attack is pain that extends from the shoulder through one or both arms and may spread into the jaw and teeth.
Cardiogenic shock develops following damage to the heart. In most cases, this is due to a lack of oxygen damaging the main pumping section — the left ventricle — though it may affect either ventricle or other parts of the heart. Various conditions can cause this damage; heart attacks and myocardial contusions are the most common. Other possible precursors include abnormal heart rhythms, heart valve problems, blood vessel obstructions, defects, and cardiomyopathy.
Numerous factors increase the risk of developing cardiogenic shock after a heart attack. Primarily, older individuals are more likely than younger people to experience heart attack complications, including cardiogenic shock. People with a history of heart failure or other heart conditions are also at increased risk. Individuals with arterial blockages, diabetes, or high blood pressure also face a greater chance. Females are statistically more likely to develop cardiogenic shock than males.
The best ways to prevent cardiogenic shock are to lower the risks of ischemic heart disease and heart attacks. Smoking and secondhand smoke increase the chance of a heart attack. However, several years after quitting, a person’s risk of a heart attack is roughly equal to a person who has never smoked. Maintaining a healthy weight is also essential to heart health, and regular exercise increases the overall health of the blood vessels and heart. In addition, following a diet that is low in cholesterol, saturated fat, sugar, and alcohol is ideal for avoiding heart issues.
Doctors have a variety of tools and tests at their disposal to diagnose cardiogenic shock. Because the event is life-threatening, most testing procedures are quick and efficient. First, doctors check the patient’s blood pressure — low blood pressure can indicate cardiogenic shock. Electrocardiograms (ECG or EKG) observe the electrical activity of the heart, which changes in the presence of cardiogenic shock. Other diagnostic methods include chest x-rays, blood tests, echocardiograms, and angiograms.
Most of the treatments for cardiogenic shock focus on limiting damage to the heart and organs. Because cardiogenic shock is usually a medical emergency, most physicians first place their patient on emergency life support. Typically, this includes a ventilator for extra oxygen and an intravenous line for medications. Most medications focus on increasing blood pressure and improving heart function and are generally intended as emergency short term treatment.
Once a person is out of immediate danger, physicians can begin to treat whatever caused the cardiogenic shock and restore proper blood flow. Sometimes the doctor may choose to insert a balloon pump into the aorta. Because this vessel is the largest artery in the body and is the closest to the heart, it is ideally located. The pump will inflate and deflate within the artery, reducing the workload of the weakened heart. The left ventricular assist device is a similar machine that takes over some of the heart’s duties following left ventricle damage.
Medical devices are not always enough to facilitate full recovery from cardiogenic shock. In such cases, patients may require surgical treatments such as angioplasties. Doctors may undertake an angioplasty if the patient has a notable blockage. The process involves inserting a long catheter tube with a balloon through an artery. The balloon inflates to open the blockage. If future blockages are a concern, doctors may insert a stent to keep the artery open. In cases of severe cardiogenic shock and heart attacks, patients may require more extensive surgeries such as coronary artery bypass or heart transplant.