Diagnosis

Cardiogenic shock is usually diagnosed in an emergency setting. Doctors will check for signs and symptoms of shock, and will then perform tests to find the cause. Tests might include:

  • Blood pressure measurement. People in shock have very low blood pressure.
  • Electrocardiogram (ECG). This test records the electrical activity of your heart via electrodes attached to your skin. If you have damaged heart muscle, electric problems or fluid buildup around your heart, it won't conduct electrical impulses normally.
  • Chest X-ray. This allows your doctor to check the size and shape of your heart and its blood vessels and whether there's fluid in your lungs.
  • Blood tests. You'll have blood drawn to check for organ damage, infection and heart attack. Another type of blood test called arterial blood gas might be used to measure oxygen in your blood.
  • Echocardiogram. Sound waves produce an image of your heart that can help identify damage from a heart attack.
  • Cardiac catheterization (angiogram). A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's inserted through an artery, usually in your leg. The dye makes your arteries visible on X-ray, revealing areas of blockage or narrowing.

Treatment

Cardiogenic shock treatment focuses on minimizing the damage from lack of oxygen to your heart muscle and other organs.

Emergency life support

Most people who have cardiogenic shock need extra oxygen. 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

Fluids and plasma, given through an IV, and medications to treat cardiogenic shock, work to increase your heart's pumping ability.

  • Inotropic agents. You might be given medications to improve your heart function, such as norepinephrine (Levophed) or dopamine, until other treatments start to work.
  • Aspirin. Emergency medical workers might give you aspirin immediately to reduce blood clotting and 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 for symptoms of a heart attack.
  • Thrombolytics. These drugs, also called clot busters or fibrinolytics, help dissolve a blood clot that's blocking blood flow to your heart. The sooner you receive a thrombolytic drug after a heart attack, the greater your chances of survival. You'll likely receive thrombolytics, such as alteplase (Activase) or reteplase (Retavase), only if emergency cardiac catheterization isn't available.
  • Antiplatelet medication. Emergency room doctors might give you drugs similar to aspirin to help prevent new clots from forming. These include medications, such as oral clopidogrel (Plavix), and platelet glycoprotein IIb/IIIa receptor blockers, such as abciximab (Reopro), tirofiban (Aggrastat) and eptifibatide (Integrilin), which are given through a vein (intravenously).
  • Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less likely to form clots. IV or injectable heparin usually is given during the first few days after a heart attack.

Medical procedures

Medical procedures to treat cardiogenic shock usually focus on restoring blood flow through your heart. They include:

  • Angioplasty and stenting. If a blockage is found during a cardiac catheterization, your doctor can insert a long, thin tube (catheter) equipped with a special balloon through an artery, usually in your leg, to a blocked artery in your heart. Once in position, the balloon is briefly inflated to open the blockage.

    A metal mesh stent might be inserted into the artery to keep it open over time. In most cases, you doctor will place a stent coated with a slow-releasing medication to help keep your artery open.

  • Balloon pump. Your doctor inserts a balloon pump in the main artery off of your heart (aorta). The pump inflates and deflates within the aorta, helping blood flow and taking some of the workload off your heart.
  • Mechanical circulatory support. Methods newer than the balloon pump are being used to help improve blood flow and supply oxygen to the body, such as extracorporeal membrane oxygenation (ECMO).

Surgery

If medications and medical procedures don't work to treat cardiogenic shock, your doctor might recommend surgery.

  • Coronary artery bypass surgery. This involves sewing veins or arteries in place at a site beyond a blocked coronary artery. Your doctor might suggest this procedure after your heart has had time to recover from your heart attack. Occasionally, bypass surgery is performed on an emergency basis.
  • Surgery to repair an injury to your heart. Sometimes an injury, such as a tear in one of your heart's chambers or a damaged heart valve, can cause cardiogenic shock. Surgery might correct the problem.
  • Ventricular assist device. A mechanical device can be implanted into the abdomen and attached to the heart to help it pump. This might extend and improve the lives of some people with end-stage heart failure who are waiting for new hearts or aren't able to have heart transplantation.
  • Heart transplant. If your heart is so damaged that no other treatments work, a heart transplant may be a last resort.