How Is Cardiogenic Shock Treated?

Cardiogenic shock is life threatening and requires emergency medical treatment. In most cases, cardiogenic shock is diagnosed after a person has been admitted to the hospital for a heart attack. If the person isn't already in the hospital, emergency treatment can start as soon as medical personnel arrive.

The goals of emergency treatment for cardiogenic shock are first to treat the shock and then to treat the underlying cause or causes of the shock.

Sometimes both the shock and its cause are treated at the same time. For example, doctors may quickly open a blocked blood vessel that's causing damage to the heart. Often, opening the blood vessel can get the patient out of shock with little or no additional treatment.

Emergency Life Support

Emergency life support treatment is required for any type of shock. This treatment helps get blood and oxygen flowing to the brain, kidneys, and other organs. Restoring blood flow to the organs is essential to keep the patient alive and to try to prevent long-term damage to the organs. Emergency life support treatment includes:

• Giving the patient extra oxygen to breathe so that more oxygen reaches the lungs, the heart, and the rest of the body.
• Giving the patient fluids, including blood and blood products, through a needle inserted in a vein (when the shock is due to blood loss). Putting more blood into the bloodstream can help get more blood to important organs and to the rest of the body. This is usually not done for cardiogenic shock because the heart can't pump the blood that's already in the body and too much fluid is in the lungs, making it difficult to breathe.

Medicines

During and after emergency life support treatment, doctors try to find out what is causing the shock. If the reason for the shock is that the heart isn't pumping strongly enough, then the diagnosis is cardiogenic shock.

Depending on what is causing the cardiogenic shock, treatment may include medicines to:

• Increase the force with which the heart muscle contracts
• Treat the heart attack that may have caused the shock

Medical Devices and Procedures

In addition to medicines, there are medical devices that can help the heart pump and improve blood flow. The devices most commonly used to treat cardiogenic shock include:

• Intra-aortic balloon pump. This device is placed in the aorta (the main blood vessel that carries blood from the heart to the body). A large balloon at the tip of the device is inflated and deflated in a rhythm that exactly matches the rhythm of the heart's pumping action. This helps the weakened heart muscle pump as much blood as it can, and gets more blood to vital organs such as the brain and kidneys.
• Angioplasty and stents. Angioplasty is a procedure used to restore blood flow through blocked coronary arteries and to treat an ongoing heart attack. A stent is a small device that's placed in a coronary artery during angioplasty to help keep it open.

Surgery

Sometimes medicine and medical devices aren't enough to treat cardiogenic shock. Surgery can restore blood flow to the heart and the rest of the body and repair damage to the heart. Surgery can help keep a patient alive while recovering from shock and improve the chances for long-term survival.

The types of surgery used to treat underlying causes of cardiogenic shock include:

• Coronary artery bypass grafting. In this surgery, arteries or veins from other parts of the body are used to bypass (that is, go around) narrowed coronary arteries.
• Surgery to repair damaged heart valves.
• Surgery to repair a break in the wall between two chambers of the heart. This break is called a septal rupture.
• Surgery to implant a device to help the heart pump blood to the body. This device is called a left ventricular assist device (LVAD) or mechanical circulatory assist. This surgery may be done if damage to the left ventricle is causing the shock. The implanted device is a battery-operated pump that takes over part of the pumping action of the heart.
• Heart transplant. This is rarely done during an emergency situation like cardiogenic shock due to the other available devices and surgery options. Also, doctors need to do very careful tests to make sure a patient will benefit from a heart transplant and to find a matching heart from a donor. Still, in some cases, doctors may recommend a transplant if they feel it's the best way to improve the patient's chances of long-term survival.