Cardiogenic shock

Diagnosis

In an emergency situation, the diagnosis of cardiogenic shock typically involves assessing for symptoms and signs of shock, followed by conducting tests to ascertain the underlying cause. These tests may include:

• Blood pressure measurement. Shocked individuals have extremely low blood pressure.
• Electrocardiogram (ECG or EKG). Using electrodes affixed to your skin, this brief, non-invasive test monitors the electrical activity of your heart. The heart won’t send electrical signals normally if you have injured heart muscle or fluid accumulation around your heart.
• Chest X-ray. A chest X-ray reveals your heart’s size and shape as well as any lung fluid.
• Blood examination. Blood will be taken from you to screen for heart attack, infection, and organ damage. To determine how much oxygen is in your blood, have an arterial blood gas test performed.
• Echocardiogram. Your heart is visualized by sound waves. This examination can assist in locating heart attack-related damage.
• Cardiac catheterization (angiogram). This examination can detect narrowed or obstructed arteries. A long, thin tube (catheter) is inserted by a doctor through an artery in your wrist or leg and is then steered toward your heart. Your arteries can be more clearly visible on an X-ray as dye passes through the catheter.

Treatment

The objective of treatment for cardiogenic shock is to mitigate the damage caused by an insufficient oxygen supply to the heart muscle and other vital organs.

Emergency life support

Most cardiogenic shock patients require more oxygen. If necessary, a ventilator will be connected to you to help your breathing. Medications and fluids will be administered to you through an intravenous (IV) line in your arm.

Medications

Through an IV line, fluids and plasma are administered. Cardiogenic shock is treated with medications that improve heart function and lower the risk of blood clots.

• Vasopressors. Low blood pressure is treated using these drugs. Dopamine, epinephrine, norepinephrine, and other substances are among them.
• Inotropic agents. Until other therapies begin to be effective, these drugs may be taken to support the heart’s pumping function. Dobutamine, dopamine, and milrinone are some of them.
• Aspirin. To prevent blood clotting and keep blood flowing through a constricted artery, aspirin is typically administered right away. Only if your doctor has advised you to do so in the past for heart attack symptoms should you take an aspirin while you are waiting for assistance.
• Antiplatelet medication. Your emergency department physician may prescribe aspirin-like medications to assist stop the formation of new clots. These drugs include eptifibatide, tirofiban, and clopidogrel.
• Other blood-thinning medications. To reduce the likelihood of blood clots, other drugs, such heparin, will likely be administered to you. Heparin is frequently administered through IV or injectable during the initial days following a heart attack.

Surgeries and other procedures

The majority of medical procedures for cardiogenic shock concentrate on getting your heart’s blood flow back to normal. They consist of:

• Angioplasty and stenting. Your doctor can introduce a long, thin tube (catheter) fitted with a specific balloon through an artery, typically in your leg, to a blocked artery in your heart if a blockage is discovered during a cardiac catheterization. Once in place, the balloon is momentarily inflated to open the obstruction.

To maintain the artery open over time, a metal mesh stent may be placed inside of it. To help keep your artery open, your doctor will typically place a stent coated with a drug that releases slowly over time.

• Balloon pump. A balloon pump is inserted by your doctor into the aorta, the main artery leaving your heart. The pump expands and contracts within the aorta to aid blood flow and lessen the strain on your heart.
• Extracorporeal Membrane Oxygenation (ECMO). ECMO increases blood flow and provides the body with oxygen. Blood is pumped outside of your body to a heart-lung machine, which filters out carbon dioxide before returning oxygen-rich blood to body tissues. If medications and other procedures don’t work to treat cardiogenic shock, your doctor might recommend surgery.
• Coronary artery bypass surgery. In this procedure, a healthy blood vessel in your arm, leg, or chest is used to make a new passageway for blood that will allow it to pass around a blocked or constricting artery. After your heart has had time to heal from your heart attack, your doctor might recommend this procedure. Sometimes bypass surgery is performed as an emergency procedure.
• Surgery to repair an injury to your heart. Cardiogenic shock can occasionally be brought on by an injury, such as a rip in one of your heart’s chambers or a damaged heart valve. Surgery could solve the issue.
• Ventricular Assist Device (VAD). To assist the heart in pumping, a mechanical device can be implanted into the abdomen and connected to it. Some patients with end-stage heart failure who are awaiting new hearts or are unable to receive a heart transplant may have their lives extended and improved by the use of a VAD.
• Heart transplant. A heart transplant may be your only option if your heart is so severely damaged that no other treatments are effective.