Cardiogenic Shock

Cardiogenic shock refers to a life-threatening medical condition in which damages in your heart are so severe that it cannot pump enough blood to supply to your vital organs.

Though rare, it can turn fatal if immediate medical care is not provided. It is most often caused by a severe heart attack.

Signs and symptoms of cardiogenic shock include: 

• “Too fast” breathing 
• Rapid shallow breathing 
• Racing heartbeat (tachycardia) 
• Fainting 
• Weak pulse 
• Heavy sweating and pale moist skin 
• Cold hands or feet 
• Reduced or no passage of urine

Cardiogenic shock is an aftermath of a severe heart attack. So, knowledge of signs and symptoms of a heart attack is equally important in assessing the situation. The signs and symptoms of a heart attack are:

• Chest discomfort characterized by pressure, fullness or a squeezing pain at the center of your chest. The pain usually lasts for more than a few minutes often radiating to your shoulder, arm, back, or even to your teeth and jaw. 
• Pain in the upper abdomen that lasts longer 
• Rapid shallow breathing
• Sweating 
• Lightheadedness or sudden dizziness 
• Nausea and vomiting 

Seek immediate help if any signs of a heart attack are present. Prompt medical care reduces your chances of developing cardiogenic shock. 

When to see a doctor? 

Cardiogenic shock is a medical emergency that requires prompt medical treatment. Early treatment is associated with improved survival rates and limited damages to your heart. If you have an ongoing attack, immediately call 911 or other emergency medical services. Ask someone to take you to the nearest medical care facility, don’t drive yourself.

The most common cause of Cardiogenic shock is reduced oxygen supply to left ventricle of your heart as a result of heart attack. Lack of oxygen supply causes damages to the cardiac muscles. Other causes of Cardiogenic shock include swollen heart muscles (myocarditis), infection of the heart valves and heart chambers (endocarditis) or drug overdoses.

The diagnosis of Cardiogenic shock in most cases is made in the emergency room. Your doctor begins the diagnosis with a detailed examination of signs and symptoms of shock followed by various tests some of which include:

• Blood pressure measurement: Blood pressure measurement is a simple test that can be done by using a pressure cuff and a stethoscope. It helps to detect if your blood pressure is normal or not. Low blood pressure is a characteristic of a cardiac shock.
• Electrocardiogram (ECG): ECG is a test that records and displays electrical activities of your heart. The impulses are recorded by using electrodes attached to various parts of your body. An ECG report contains patterns of the electrical impulses which can be compared with an ECG obtained from a person with cardiogenic shock.
• Chest X-ray: A chest X-ray shows picture of organs present in the chest like heart, lungs and blood vessels. By looking at an X-ray, your doctor can draw an idea if your heart is in normal shape and size or not. Also, it helps to detect if any fluid is present in the lungs.
• Blood tests: Analysis of your blood sample can reveal information on organ damage, organ functions, infection and heart attack. Another type of blood test called arterial blood gas measurement allows for measuring oxygen, carbon dioxide and pH levels in the blood.
• Echocardiogram: Also called an Echo, it uses sound waves to create a picture of your heart that provides information about the damage caused by a heart attack. 
• Coronary catheterization (angiogram): A catheter is passed through an artery in the leg to the coronary arteries followed by injection of a liquid dye into the catheter. As the dye moves, its movement can be detected to determine if there is any disturbance in the flow of blood, probably due to narrowing of the arteries.

Cardiogenic shock treatment is aimed at reducing the damage to your heart muscle and other organs caused by insufficient oxygen supply. You might receive an extra amount of oxygen and IV fluids to keep you alive. If needed, ventilation may also be recommended.

1. Medications 

• Aspirin: Your doctor may give you aspirin as soon as you reach the hospital. Aspirin is a drug that reduces blood clotting and facilitates blood flow through a narrowed artery. You may take aspirin on your own before the medical help arrives. 
• Thrombolytics: A thrombolytic agent, also called clot buster is a blood thinner that helps to dissolve the clot and hence reopen a narrowed or blocked artery. Earlier use of thrombolytic is associated with greater chances of survival and lower cardiac damages. These agents are useful when emergency cardiac catheterization isn't available. 
• Superaspirins: Your doctors may give you other aspirin-like agents such as oral clopidogrel and intravenous “platelet glycoprotein IIb/IIIa receptor blockers” to prevent the formation of new clots. IV Heparin may also be given during first few days after a heart attack for the same purpose.
• Inotropic agents:  These agents increase your heart’s pumping ability. Drugs such as dopamine or dobutamine are used before other medications start to work.

2. Medical procedures: Medical procedures and surgery are aimed at restoring blood flow through your heart. They include: 

• Angioplasty and stenting: It is a procedure used to reopen a blocked artery and keep it open over time by using a catheter with a balloon at one end which is inserted through an artery (usually in the leg) to the narrowed artery in your heart. Once in position, the balloon is briefly inflated to open the blockage. A metal mesh stent may be inserted into the artery to keep it open over time. Your doctor might use stents that are coated with a slow-releasing medication to help keep the artery open for a long time.
• Balloon pump: Also called intra-aortic balloon pump, it is a device that increases myocardial oxygen and cardiac output. The pump is inserted into the aorta through surgery which helps to take some load off the heart as it inflates and deflates.
• Surgery: When medications and medical procedures are not enough treat cardiogenic shock, your doctor may recommend surgery.
• Coronary artery bypass surgery: This involves redirecting blood flow in the heart by skipping the narrowed portion of the vessel. 
• Surgery to repair an injury to your heart: Surgery can be performed to correct the injury in one of your heart's chambers or a valve that has caused cardiogenic shock. 
• Heart pumps: Also called ventricular assist devices, these pumps are implanted inside the chest and assist your heart in pumping blood throughout the body. These pumps are useful if you have end-stage heart failure and waiting for a new heart. 
• Heart transplant: This is the last option available if your heart is so extensively damaged that no other treatments work for you.

Preventing a heart attack is the best way to prevent cardiogenic shock. Some common lifestyle modifications for a healthy heart are:

• Keep your blood pressure in check with medications, exercise
• Stay active, exercise for most days of the week
• Limit salt and alcohol intake 
• Quit smoking
• Maintain a healthy weight: Being obese or overweight contributes to other risk factors for heart attack and cardiogenic shock, such as high blood pressure, cardiovascular disease and diabetes
• Cut down on cholesterol and saturated fat

If you have a heart attack, your risk of developing cardiogenic shock increases with: 

• Age 
• History of heart failure or heart attack 
• Coronary artery disease (narrowing of arteries in your heart) 
• Diabetes 
• High blood pressure

Complications

If not treated immediately, cardiogenic shock can be fatal. Cardiogenic shock can cause permanent damages to vital organs of your body including your liver, kidneys and brain.