Cardiogenic shock treatment focuses on repairing the damage to your heart muscle and other organs caused by lack of oxygen.
Emergency life support
Emergency life support is a necessary treatment for most people who have cardiogenic shock. During emergency life support, you're given extra oxygen to breathe to minimize damage to your muscles and organs. If necessary, you'll be connected to a breathing machine (ventilator). You'll receive medications and fluid through an intravenous (IV) line in your arm.
Medications to treat cardiogenic shock work to improve blood flow through your heart and increase your heart's pumping ability.
- Aspirin. You may be given aspirin by emergency medical personnel soon after they arrive on the scene or as soon as you get to the hospital. Aspirin reduces blood clotting and helps keep your blood flowing through a narrowed artery. Take an aspirin yourself while waiting for help to arrive only if your doctor has previously told you to do so if symptoms of a heart attack occur.
- Thrombolytics. These drugs, also called clot busters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and lessen the damage to your heart. You'll usually receive thrombolytics only if emergency cardiac catheterization isn't available.
- Superaspirins. Doctors in the emergency room may give you other drugs that are similar to aspirin to help prevent new clots from forming. These include medications, such as clopidogrel (Plavix) and others called platelet glycoprotein IIb/IIIa receptor blockers.
- Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less likely to form more dangerous clots. Heparin is given intravenously or by an injection under your skin and is usually used during the first few days after a heart attack.
- Inotropic agents. You may be given medications, such as dopamine or epinephrine, to improve and support your heart function until other treatments start to work.
Medical procedures to treat cardiogenic shock usually focus on restoring blood flow through your heart. They include:
- Angioplasty and stenting. Usually, once blood flow is restored through a blocked artery, the signs and symptoms of cardiogenic shock improve. Emergency angioplasty opens blocked coronary arteries, letting blood flow more freely to your heart. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg, to a blocked artery in your heart. This catheter is equipped with a special balloon. Once in position, the balloon is briefly inflated to open up a blocked coronary artery. At the same time, a metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. In most cases, you doctor will place a stent coated with a slow-releasing medication to help keep your artery open.
- Balloon pump. Depending on your condition, your doctors may choose to insert a balloon pump in the main artery of your heart (aorta). The balloon pump inflates and deflates to mimic the pumping action of your heart, helping blood flow through.
If medications and medical procedures don't work to treat cardiogenic shock, your doctor may recommend surgery.
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- Coronary artery bypass surgery. Bypass surgery involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary artery. This restores blood flow to the heart. Your doctor may suggest that you have this procedure after your heart has had time to recover from your heart attack.
- Surgery to repair an injury to your heart. Sometimes an injury in your heart, such as a tear in one of your heart's chambers or a damaged heart valve, can cause cardiogenic shock. If an injury causes your cardiogenic shock, your doctor may recommend surgery to correct the problem.
- Heart pumps. These mechanical devices, called ventricular assist devices (VADs), are implanted into the abdomen and attached to a weakened heart to help it pump. Implanted heart pumps can extend and improve the lives of some people with end-stage heart failure who aren't eligible for or able to undergo heart transplantation or are waiting for a new heart.
- Heart transplant. If your heart is so damaged that no other treatments work, a heart transplant may be a last resort for treating cardiogenic shock.
- Cardiogenic shock. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/shock/shock_what.html. Accessed July 27, 2011.
- Reynolds HR, et al. Cardiogenic shock: Current concepts and improving outcomes. Circulation. 2008;117:686.
- Goldberg RJ, et al. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction. Circulation. 2009;119:1211.
- Menon V, et al. Prognosis and treatment of cardiogenic shock complicating acute myocardial infarction. http://www.uptodate.com/home/index.html. Accessed July 27, 2011.
- Hochman JS, et al. Clinical manifestations and diagnosis of cardiogenic shock. http://www.uptodate.com/home/index.html. Accessed July 27, 2011.