Cardiogenic Shock Causes, Stages, and Treatments

Cardiogenic shock is a serious condition that can result in death if medical attention is not sought out quickly. This condition occurs when the heart is no longer able to pump enough blood to meet the needs of your body. When there is not enough blood and oxygen making their way to the organs, it can result in organ failure and eventually death if not treated right away.

This medical issue is more common than a lot of people might imagine. Annually in the United States, there are around 50,000 people who suffer from cardiogenic shock. This is the leading cause of death in people who have a heart attack.

Cardiogenic Shock Causes

Even though it’s the top cause of death in people who have a heart attack, and it is the most common cause of cardiogenic shock, having a heart attack does not always lead to cardiogenic shock.

When someone has a severe heart attack, they may suffer damage to the left ventricle, which is the main pumping chamber for the heart. If this happens, it hampers the body’s ability to pump blood. The left ventricle is often the one that receives the most damage and causes cardiogenic shock. However, it could also happen to the right ventricle.

In addition to heart attacks, you will find other potential causes of cardiogenic shock. There could be inflammation in the heart muscle or an infection in the heart. Those who suffer from an abnormal heart rhythm are at a higher risk of having cardiogenic shock, as well.

Having too much blood around the heart, blood clots, or tears in the valves of the heart could lead to cardiogenic shock, too. Even if someone is considered healthy and has a good heart, an injury to the chest could damage the heart and lead to cardiogenic shock.

Types of Cardiogenic Shock: The Stages

Cardiogenic shock has several stages. The amount of time that each stage lasts can vary from one patient to the next, of course. Additionally, medical attention at earlier stages can sometimes help to curb the problem before it becomes worse.

Some people may have heart disease and other cardiac issues. This might include suffering a heart attack or heart failure but not having signs of cardiogenic shock. These issues don’t always lead to shock.

Those who don’t take steps to reduce their risk at this point may then proceed to what most consider the first stage of cardiogenic shock. This is where they have a lowered blood pressure or heart rate. Essentially, they aren’t pumping enough blood to the organs.

The next stage is when the patient starts to need medicine or medical devices that can help them get blood to their organs.

The following stage is entered if a patient is not responding to those devices or medicine, and they continue to get worse. The patient could then progress to a stage where they enter cardiac arrest and need CPR, a ventilator, or a defibrillator. At this point, it can be difficult for the patient to survive.

Ideally, patients will start to notice that they have issues with their heart as early as possible, so it never progresses beyond those initial stages. However, that’s not often the case.

What Treatments Will the Doctors Perform?

Diagnosis of Cardiogenic Shock and Emergency Treatment

First, the doctors will need to determine whether the patient has cardiogenic shock or another health issue. There are multiple tests, including lab tests, that doctors can use to provide a proper diagnosis. The treatment will depend on a range of factors including the stage of shock.

The goal is always to ensure that you have enough blood flowing from and to your heart and organs to remain healthy. This might require the use of medications, often provided by IV in cases of emergency. The patient might also have to go on oxygen to increase the amount of O2 in their blood.

Additional Treatment

After emergency medical treatment has been provided, there will likely need to be additional treatment. Again, this will vary based on the cause of the cardiogenic shock. In some cases, it might result in stent placement, heart valve repair, or a bypass. Those who have fluid around the heart will need to have it removed via a needle. This stops the compression of the heart.

Each case is different. Patients and their loved ones will want to speak with the doctors about the available options. Those who feel they may be in danger of suffering cardiogenic shock should start finding ways to reduce that risk. Talk with a doctor about medications to take and lifestyle changes to make.

Cardiovascular Research and Training Institute (CVRTI)

Researchers at the CVRTI use a multidisciplinary approach to study every aspect of cardiogenic shock from the cell to the bedside.  We have Investigators who study the cell response to lack of oxygen (Chaudhuri, Hoareau, Lesniewski, Palatinus, Selzmen)  and ways to preserve heart tissue when blood flow is compromised in cardiogenic shock.  Individual cells are injured when blood flow is lost and receive additional injury when blood flow is restored (termed reperfusion injury) (Hoareau, Shaw).  Keeping individual cells alive in the setting of shock is critical to patient survival. On the other end of the spectrum, our investigators study methods of maintaining the normal heart rhythm as abnormal heart rhythms a can contribute to cardiogenic shock (Aromolaran, Dosdall, MacLeod, Ranjan, Shaw, Tristani).  Our investigators have access to heart tissue from patients who have received heart transplants for cardiogenic shock to study changes in proteins and molecular signals in response to this condition (Drakos, Hong, Shaw).

What are the Signs and Symptoms of Cariogenic Shock?

Cardiogenic shock occurs when the heart has been damaged to the point that it is no longer capable of supplying enough blood and oxygen to the body’s organs. This has the potential to be a serious medical condition that can lead to many health issues and even death. Below, you’ll learn more about cardiogenic shock including signs and symptoms to watch out for.

Why Does Cardiogenic Shock Occur?

The most common causes of cardiogenic shock are serious heart conditions. These could occur during or after a heart attack, for example. When this occurs, a portion of the heart muscle may no longer move properly, or not at all. Damage from a heart attack might also cause a rupture in the heart muscle.

Pressure on the heart, tears of muscles or tendons that support heart valves, ruptures in the wall between the left and right ventricles, and slow or erratic heart rhythms could cause the progression of cardiogenic shock, as well.

Understanding Progression of Cardiogenic Shock and Criteria

Cardiogenic shock progresses through four stages—initial, compensatory, progressive, and refractory.

In the initial stage, the heart output is diminished, but there aren’t any clinical symptoms that would necessarily be noticed. When it moves to the compensatory stage, the body responds to the decreased cardio output and essentially starts to change the blood pressure in the body. This can start to cause a host of issues in the body.

Next comes the progressive stage if there is no intervention to help the blood pressure return to normal, get healthier, and reverse the problem. At this stage, the heart is under increased demand, which can lead to metabolic acidosis and fluid leakage from the capillaries. This can cause clotting in the capillaries and tissue death. Cardiac output is further reduced at this stage and will eventually lead to the refractory stage if there is no intervention. The chance of survival when cardiogenic shock gets to this stage is limited.

At this stage, there are also often other complications that arise, which can make treatment even more difficult. Some of these complications include organ failure, stroke, and cardiopulmonary arrest.

Cardiogenic Shock: Examples of Symptoms

If you or a loved one is suffering from cardiogenic shock, you will want to be aware of some of the most common signs. If you feel any of these issues, you must get in touch with your doctor right away. Often, going to the emergency room is the best course of action when dealing with any type of heart issue, even if you may not think it is serious.

Some Of the Most Common Signs And Symptoms Include:

• Pressure or pain in the chest
• Heavy, increased sweating
• Moist, clammy skin
• Skin that is cool to the touch
• Fast breathing
• Elevated pulse or a weak pulse
• Restlessness
• Agitation
• Lightheadedness
• Trouble concentrating or confusion
• Not being alert
• Blotchy skin or pale skin
• Shortness of breath
• Less than normal urination (or no urination at all)
• Nausea/vomiting
• Loss of consciousness

As mentioned above, these are serious issues, and you will want to have them checked out by a medical practitioner sooner rather than later. Even if a patient isn’t in any of the stages of cardiogenic shock, it is always better to have the help and guidance of a professional, who can perform exams and tests to get to the root of the problem.

What Sorts of Tests Are Administered for Diagnosis?

Some of the types of tests that may be administered as a means to diagnose cardiogenic shock include chest x-rays, cardiac catheterization, coronary angiography, echocardiograms, electrocardiograms, and nuclear scans of the heart.

Lab tests may be ordered, as well, to determine the problem with the heart. These tests could include a complete blood count, blood chemistry, and checking arterial blood gas, for example.

Treatment for Cardiogenic Shock

It is important to understand that cardiogenic shock is a medical emergency. Patients will need to stay in the hospital while the doctors attempt to find and treat the cause, so they can help to save their life.

Some of these treatments might include various medicine meant to improve heart function and increase blood pressure. Medicines like vasopressin, epinephrine, and dopamine could help in the short term. Other treatments, such as pacemakers, ventricular assist devices, surgery, and heart monitoring may be required, as well.

Whenever you or a loved one has any health issues, such as those described above, make it a point to get in touch with a doctor as soon as possible.

Cardiovascular Research and Training Institute (CVRTI)

Researchers at the CVRTI use a multidisciplinary approach to study every aspect of cardiogenic shock from the cell to the bedside.  We have Investigators who study the cell response to lack of oxygen (Chaudhuri, Hoareau, Lesniewski, Palatinus, Selzmen)  and ways to preserve heart tissue when blood flow is compromised in cardiogenic shock.  Individual cells are injured when blood flow is lost and receive additional injury when blood flow is restored (termed reperfusion injury) (Hoareau, Shaw).  Keeping individual cells alive in the setting of shock is critical to patient survival. On the other end of the spectrum, our investigators study methods of maintaining the normal heart rhythm as abnormal heart rhythms a can contribute to cardiogenic shock (Aromolaran, Dosdall, MacLeod, Ranjan, Shaw, Tristani). Our investigators have access to heart tissue from patients who have received heart transplants for cardiogenic shock to study changes in proteins and molecular signals in response to this condition (Drakos, Hong, Shaw).

Understanding the Stages of Cardiogenic Shock, Risk Factors, and Treatment

Cardiogenic shock is an emergent condition that can damage organs, cause brain injury, or even be fatal if it isn’t recognized and treated quickly. The good news is that cardiogenic shock can be managed if it’s addressed right away.

Defining Cardiogenic Shock

Cardiogenic shock is the term for what happens after the heart can no longer move blood and oxygen throughout your body. Usually, this happens after a serious heart attack, but other issues, such as heart failure, injury or internal bleeding, or blood clots can also cause it. Sometimes, certain medications can also be a cause of cardiogenic shock if they’re taken in too high a dose.

The Severity of the Various Stages of Cardiogenic Shock

The body works as an alarm system, putting out signs and symptoms of distress that get “louder” and more alarming as one’s condition worsens. Since the heart is responsible for moving oxygenated blood to all other organs and areas of the body, it makes sense that all other systems will be affected when a body is going into cardiogenic shock.

Initial symptoms include confusion, nausea, sweating, and rapid breathing. Someone might also experience a slowed or rapid pulse and lower blood pressure.

Individual Symptoms Range From Among The Following List

• Trouble breathing (e.g., rapid breathing, can’t catch breath)
• Bulging neck vein(s)
• Cold, clammy skin, especially on the hands and feet
• Sweating
• Fainting; loss of consciousness
• Swollen feet
• Urinary changes (e.g., more or less than normal)

These are all closely related. For example, the heart not being able to pump as much blood through the body means lower blood pressure, so the body limits blood flow to the extremities, causing cold, clammy hands and feet. Less blood flow to the brain causes confusion or loss of consciousness, and decreased blood to the kidneys means they will shut down and stop producing urine. When the heart doesn’t pump enough blood through the body, blood can back up into the lungs and it becomes harder to breathe.

In rare cases, a person might have no symptoms at all and then immediately lose consciousness. Of course, if this happens, call 911 immediately.

Cardiogenic Shock Risk Factors

Cardiogenic shock is often caused by an initial heart attack, but it could be caused by other issues such as chest injury, pulmonary embolism, previous heart trouble, or improperly taken medications.

Cardiogenic Shock Guidelines for 2022

If you suspect that someone is suffering from cardiogenic shock, call 911 right away. The emergency team can help you with the initial steps while an ambulance arrives to take the patient to the hospital.

Once someone has initially recovered from cardiogenic shock, they need further treatment to help their heart and body recover. It’s important to get the blood flowing again so that other organs aren’t damaged.

Because of the life threatening nature of cariogenic shock, it must be treated in the hospital.  There, the medical team will administer medications and therapies to help the heart pump more efficiently.  These may include anti-arrhythmia medications to bring the heart back to normal function as well as blood thinners or antiplatelet medications to dissolve clots or blockages. They might also prescribe medications that increase blood pressure and blood flow.

Depending on the severity of the heart damage, the patient might need to be placed on a heart transplant list or have a stent placed to keep blood flowing to the heart. If the cardiogenic shock was serious enough, or a significant amount of time passed before medical treatment took place, a patient might need any of the following:

• Kidney dialysis to filter out waste
• IV fluids to maintain normal blood volume
• Ventilator or oxygen therapy to open and protect the breathing passages and provide adequate oxygen to the entire body
• Temporary mechanical pump placement to off load the heart and keep blood moving forward

Conclusion

Cardiogenic support is a serious condition that can lead to further damage. If you or a loved one are at risk for heart problems, familiarize yourself with the signs and symptoms of cardiogenic shock, as well as the cardiogenic shock guidelines for 2022 so that you know what to do in case of an emergency.

Cardiovascular Research and Training Institute (CVRTI)

Researchers at the CVRTI use a multidisciplinary approach to study every aspect of cardiogenic shock from the cell to the bedside.  We have Investigators who study the cell response to lack of oxygen (Chaudhuri, Hoareau, Lesniewski, Palatinus, Selzmen) and ways to preserve heart tissue when blood flow is compromised in cardiogenic shock.  Individual cells are injured when blood flow is lost and receive additional injury when blood flow is restored (termed reperfusion injury) (Hoareau, Shaw).  Keeping individual cells alive in the setting of shock is critical to patient survival. On the other end of the spectrum, our investigators study methods of maintaining the normal heart rhythm as abnormal heart rhythms a can contribute to cardiogenic shock (Aromolaran, Dosdall, MacLeod, Ranjan, Shaw, Tristani). Our investigators have access to heart tissue from patients who have received heart transplants for cardiogenic shock to study changes in proteins and molecular signals in response to this condition (Drakos, Hong, Shaw).

2022 Heart Disease And Statistics You Need to Know

Heart Disease Research Conducted at Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI)

Arrhythmias, congestive heart failure, high blood pressure, cardiac arrest are all different types of heart diseases. Some of these can be controlled or prevented through diet, exercise, or medications, but some are sudden and unexpected. Some people are born with heart disease, and some develop heart disease through lifestyle choices. While there are many types and causes of heart disease, it is important to be aware of the symptoms. Heart disease can be a lethal disease, but with treatment, it can be managed. Below are 6 shocking heart disease statistics.

Heart Disease Is The Leading Cause Of Death In The United States

Among men and women from different ethnic and racial groups, heart disease is unfortunately seen among all of them. Data collected from 1999 through 2018 shows heart disease has been the leading cause of death of adults in the United States. To prevent heart disease, it is important to be educated on the signs and symptoms of heart disease and perform routine tests with your doctor.

Every 30 seconds someone in the United States passes away from heart disease

Heart disease can be deadly, especially when diagnosed late. The earlier the diagnosis, the more opportunities to stop or reverse the damage. Emergency rooms and medical professions see patients daily who have various heart disease conditions; some arrive with late stages or untreated heart disease. The best prevention for heart disease is to monitor heart health, control diet, and exercise. Your physician can work with you to develop a comprehensive care plan for heart health.

25% of all deaths in the United States are linked to heart disease

To prevent heart disease and heart disease-related deaths, it is important to notice the symptoms. Symptoms of heart disease include fluttering heart, chest pains, shortness of breath, swelling in lower extremities, upper body discomfort.

Roughly $400 billion is spent on heart disease annually in the United States.

Individually, patients with heart disease and their families can feel the financial burden from heart disease. As heart disease conditions progress, some patients have to take time off of work in addition to the cost of treatment and medications. In the United States, it is estimated to be roughly $400 billion spent annually on heart disease through health services, medications, and loss of wages.

The most common type of heart disease is coronary heart disease

Coronary heart disease is when the arteries struggle to deliver oxygen-rich blood to the heart. Annually in the United States, roughly 400,000 people die from coronary heart disease. Some patients of coronary heart disease experience no symptoms.

20% of all heart attacks in the United States are silent

Most patients who experience a heart attack will feel the damage and can receive treatment. However, 20% of heart attack patients will not exhibit any symptoms and have no idea about the damage occurring to their heart. Patients can survive a silent heart attack, and it can be diagnosed after it occurs using imaging technology.

Heart disease is a very dangerous and deadly disease. Everyone’s health can benefit from practicing healthy heart habits. Patients with diabetes, excessive weight, unhealthy diets, and sedentary lifestyles are especially at risk.

Cardiovascular Research & Training Institute

At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), we have a broad array of research teams studying multiple aspects of heart disease. Not only do we perform cutting edge basic research, we also can take our discoveries from the bench to more translational pre-clinical studies, to clinical research in humans. 

We have researchers exploring metabolism in the heart focusing on the linkage between mitochondria and failing hearts and arrhythmia. Other researchers are investigating heart muscle cells during disease progression and how the function of ion channels and signaling proteins differ in normal and failing hearts.

The ultimate goal of heart disease research at the CVRTI is to provide interventional therapies by utilizing translational medicine to create a true ‘bench to bedside’ approach at reducing the impact of heart failure.  Researchers are examining the dangerous effects of cardiac arrhythmia and possible therapeutic interventions to minimize or reverse the progression of heart disease. Other researchers focus on treatment options associated with ion channels ‘becoming lost’ in the diseased heart while on their way to their proper locations within the heart.

Research Labs

Drakos Laboratory

The Drakos Laboratory, headed by Stavros Drakos, MD, PhD, focuses on understanding the metabolic and molecular profile of the failing and recovered heart and utilizes biological information derived from studies in humans, small, and large animal HF models to understand, predict and manipulate myocardial recovery. Original work generated by the Drakos research team in the laboratory and in the clinical arena led to the founding and establishment of the award winning multidisciplinary Utah Cardiac Recovery Program (UCAR). Link to lab summary page on CVRTI

Sachse Laboratory 

The Sachse Laboratory, headed by Frank Sachse, PhD, provides insights into structural and functional remodeling in diseased hearts and mechanisms of cardiac recovery after clinical therapy. They also develop optical approaches to support pediatric heart surgery and interventional cardiology.

Shaw Laboratory

The Shaw Laboratory, headed by Robin Shaw, MD, PhD, is focused on understanding the cell biology of heart arrhythmias and heart failure progression. Link to lab summary page on CVRTI The Shaw Laboratory, headed by Robin Shaw, MD, PhD, is focused on understanding the cell biology of heart arrhythmias and heart failure progression. Link to lab summary page on CVRTI

Ranjan Laboratory

The Ranjan Laboratory, headed by Ravi Ranjan, MD, PhD, focuses on developing a better understanding of arrhythmia mechanisms and optimizing the ablation procedure. The lab is using a combination of high density electrical mapping and imaging in an animal model combined with computational modeling to develop a better understanding of arrhythmia mechanisms. To optimize the ablation procedure, the team uses MRI to quantify tissue changes including reversible edema over time for different energy sources and ablation parameters to develop the optimal ablation technique. Link to lab summary page on CVRTI