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Cardiogenic Shock

Cardiogenic shock is a condition in which a suddenly weakened heart isn't able to pump enough blood to meet the body's needs. The condition is a medical emergency and is fatal if not treated right away.

PubMed Health Glossary
(Source: NIH - National Heart, Lung, and Blood Institute)

Cardiogenic Shock

Cardiogenic (kar-dee-oh-JE-nik) shock is a condition in which a suddenly weakened heart isn't able to pump enough blood to meet the body's needs. The condition is a medical emergency and is fatal if not treated right away.

The most common cause of cardiogenic shock is damage to the heart muscle from a severe heart attack. However, not everyone who has a heart attack has cardiogenic shock. In fact, on average, only about 7 percent of people who have heart attacks develop the condition.

If cardiogenic shock does occur, it's very dangerous. When people die from heart attacks in hospitals, cardiogenic shock is the most common cause of death.

What Is Shock?

The medical term "shock" refers to a state in which not enough blood and oxygen reach important organs in the body, such as the brain and kidneys. Shock causes very low blood pressure and may be life threatening.

Shock can have many causes... Read more about Cardiogenic Shock

What works? Research summarized

Evidence reviews

Myocardial Infarction with ST-Segment Elevation: The Acute Management of Myocardial Infarction with ST-Segment Elevation [Internet]

When myocardial blood flow is acutely impaired (ischaemia), and often not provoked by exertion, a person will commonly suffer more prolonged pain; this is referred to as acute coronary syndrome (ACS). The underlying common pathophysiology of ACS involves the erosion or sudden rupture of an atherosclerotic plaque within the wall of a coronary artery. Exposure of the circulating blood to the cholesterol-rich material within the plaque stimulates blood clotting (thrombosis), which obstructs blood flow within the affected coronary artery. This coronary obstruction may be of short duration, and may not result in myocardial cell damage (necrosis), in which case the clinical syndrome is termed unstable angina. Unstable angina may result in reversible changes on the electrocardiogram (ECG) but does not cause a rise in troponin, a protein released by infarcting myocardial cells. Ischaemia which causes myocardial necrosis (infarction) will result in elevated troponin. When the ischaemia-causing infarction is either short-lived or affects only a small territory of myocardium the ECG will often show either no abnormality or subtle changes. This syndrome is termed non-ST-segment elevation myocardial infarction (NSTEMI). The diagnosis and immediate management of STEMI and the management of unstable angina and NSTEMI is addressed in other NICE Clinical Guidelines (CG95 and CG94).

Intra‐aortic balloon counterpulsation in patients with acute myocardial infarction and cardiogenic shock

Cardiogenic shock is a severe condition in which a suddenly weakened heart is not able to pump enough blood to meet the body's energy needs, so not enough oxygen will reach the body’s organs. Cardiogenic shock is a life‐threatening medical emergency and needs to be treated quickly to avoid organ damage or even death of the affected patient. Most often cardiogenic shock is caused by a severe heart attack and the induced damage to the heart muscle. Despite more than 50 years of effort, patients with cardiogenic shock still have a poor prognosis after primary revascularization procedures such as coronary artery bypass grafting or primary percutaneous coronary intervention. The main cause for the development of cardiogenic shock is the loss of myocardial function due to myocardial infarction leading to impaired left ventricular function with unstable haemodynamics and reduced systolic and mean arterial pressures. The reduced blood pressure leads to hypoperfusion and so reduced oxygen supply to vital organs and the corresponding clinical signs. These include cold and pale skin, reduced or a lack of urine output and signs of impaired cerebral function like dizziness or even unconsciousness.

Inotropic and vasodilator strategies in patients with a heart attack (acute myocardial infarction) and cardiogenic shock or low cardiac output

Cardiogenic shock occurring in 5% to 10% of patients with acute myocardial infarction still remains a life‐threatening complication. As regards treatment options with inotropic and vasoactive drugs for infarct related cardiogenic shock, there is only very little evidence generated by randomised controlled trials.

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Summaries for consumers

Intra‐aortic balloon counterpulsation in patients with acute myocardial infarction and cardiogenic shock

Cardiogenic shock is a severe condition in which a suddenly weakened heart is not able to pump enough blood to meet the body's energy needs, so not enough oxygen will reach the body’s organs. Cardiogenic shock is a life‐threatening medical emergency and needs to be treated quickly to avoid organ damage or even death of the affected patient. Most often cardiogenic shock is caused by a severe heart attack and the induced damage to the heart muscle. Despite more than 50 years of effort, patients with cardiogenic shock still have a poor prognosis after primary revascularization procedures such as coronary artery bypass grafting or primary percutaneous coronary intervention. The main cause for the development of cardiogenic shock is the loss of myocardial function due to myocardial infarction leading to impaired left ventricular function with unstable haemodynamics and reduced systolic and mean arterial pressures. The reduced blood pressure leads to hypoperfusion and so reduced oxygen supply to vital organs and the corresponding clinical signs. These include cold and pale skin, reduced or a lack of urine output and signs of impaired cerebral function like dizziness or even unconsciousness.

Inotropic and vasodilator strategies in patients with a heart attack (acute myocardial infarction) and cardiogenic shock or low cardiac output

Cardiogenic shock occurring in 5% to 10% of patients with acute myocardial infarction still remains a life‐threatening complication. As regards treatment options with inotropic and vasoactive drugs for infarct related cardiogenic shock, there is only very little evidence generated by randomised controlled trials.

Naloxone may improve blood pressure in people who are in shock but more trials are needed to show whether this reduces deaths

When people go into shock, their blood pressure drops and may be too low to sustain life. One theory about the cause of this is the effect of the opiates that the body produces after major blood loss or trauma. Naloxone is a drug that counteracts the effects of opiates. It has been tried as a treatment to reduce the impact of shock. This review of trials found that giving naloxone to people in shock improves their blood pressure. It is not clear whether or not this improves their overall condition or reduces their chances of dying. More trials are needed.

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Terms to know

Blood
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
Blood Pressure
The force of blood exerted on the inside walls of blood vessels. Blood pressure is expressed as two numbers. For example, a blood pressure result of 120/80 is said as "120 over 80."
Cardiac
Having to do with the heart.
Heart
The hollow, muscular organ that maintains the circulation of the blood.
Hypotension
Hypotension is abnormally low blood pressure. Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood.
Myocardial Infarction (Heart Attack)
A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked. If blood flow isn't restored quickly, the section of heart muscle begins to die.

More about Cardiogenic Shock

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Also called: Cardiac shock syndrome

Other terms to know: See all 6
Blood, Blood Pressure, Cardiac

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