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Cardiogenic Shock


Overview, Causes, & Risk Factors

Cardiogenic shock is the failure of your heart to pump enough blood to your major organs to support life.

What is going on in the body?

Any process that interferes with the pumping action of your heart or that causes severe injury to your heart can cause shock. Failure of your heart to pump enough blood to your major organs causes them to stop working. This is a medical emergency, and this condition can cause death quickly.

What are the causes and risks of the condition?

Any disease that affects the ability of the heart to function can cause this condition. Some of the common causes of cardiogenic shock are as follows:

  • a blood clot to the lungs, known as a pulmonary embolus
  • a buildup of fluid around the heart, known as pericardial effusion
  • certain irregular heart beats, called arrhythmias
  • congestive heart failure
  • a massive heart attack

  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    The signs and symptoms of cardiogenic shock are partly related to the organs that are failing and include:

  • cold and clammy skin
  • confusion
  • decreased urination
  • low blood pressure
  • shortness of breath
  • rapid breathing
  • stroke, also called a brain attack, which is damage to the brain from not enough oxygen
  • a weak pulse
  • Some symptoms and signs depend on the reason the heart is not pumping well. For example, the heart rate is usually fast, but the rate could be abnormally low in other cases.


    Diagnosis & Tests

    How is the condition diagnosed?

    Cardiogenic shock is generally diagnosed from your medical history and physical examination. Figuring out the underlying cause is very important, and will require further testing. For example, blood tests and a heart tracing, called an ECG, may be done if a heart attack is suspected. Plain or special X-ray tests are also frequently done.


    Prevention & Expectations

    What can be done to prevent the condition?

    If you have heart disease, you should seek medical attention if your condition gets worse for any reason. Prompt medical attention may catch problems before shock occurs. Taking your medicines as prescribed can also prevent shock. Prevention of coronary artery disease is probably the best way to prevent this condition. Control of coronary risk factors such as high blood pressure, diabetes, smoking, and high cholesterol can also help.

    What are the long-term effects of the condition?

    If untreated, this condition usually causes death. If you survive, the long-term effects depend on the cause and the speed of diagnosis and treatment. Permanent organ damage, especially to the kidney and brain, can occur.

    What are the risks to others?

    There are no risks to others.


    Treatment & Monitoring

    What are the treatments for the condition?

    The goal of medical therapy is to improve your heart's ability to pump. How your doctor treats you will depend on the underlying cause of the shock. Many different medicines and devices may be used to try to restore heart function and blood flow. Some of these include:

  • adding or removing fluids, such as blood, water, or salt
  • heart assist devices, such as a pacemaker
  • heart medicines to help the heart pump more effectively, such as digitalis
  • medicines to dissolve blood clots
  • medicines to help open up, or dilate, certain blood vessels
  • oxygen therapy
  • surgery
  • a ventilator, or artificial breathing machine
  • What are the side effects of the treatments?

    All medicines have possible side effects. Ventilators increase the risk of infection. Surgery can be associated with bleeding, infection, and in some cases, death.

    What happens after treatment for the condition?

    If you survive, aggressive treatment and close monitoring of the underlying disease is needed. In some people, a heart transplant may have to be done to fix the underlying problem. Your doctor will also test you for any permanent organ damage.

    How is the condition monitored?

    Results of blood tests and urine output are strictly monitored. Progress in the treatment of the underlying disease is also carefully monitored. X-rays and other tests may be required in some cases. Always report any new or worsening symptoms to your doctor.


    Attribution

    Author:Eric Berlin, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:09/30/01
    Reviewer:Adam Brochert, MD
    Date Reviewed:05/02/01

    Sources

    Harrison's Principles of Internal Medicine, 1991

    Merck Manual, 1999

    Current Medical Diagnosis and Treatment, 1996


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