Cardiogenic shock is a life-threatening condition in which the heart is unable to pump enough blood to meet the body’s needs, causing a critical fall in blood pressure and inadequate oxygen delivery to vital organs. It is the most severe form of cardiac failure and a recognised complication following cardiac arrest, large heart attacks, and severe cardiomyopathy.
How it differs from cardiac arrest
Cardiac arrest is the sudden cessation of effective heart pumping, resulting in no pulse and loss of consciousness. Cardiogenic shock describes a state in which the heart is still beating, but so weakly that circulation is severely compromised. A person in cardiogenic shock is critically ill and conscious (or partially conscious), whereas a person in cardiac arrest is unresponsive and requires immediate CPR and defibrillation.
Causes
The most common cause is a large acute myocardial infarction (heart attack) affecting a substantial area of the left ventricle. Other causes include dilated cardiomyopathy, severe valve disease, myocarditis, and post-cardiac arrest syndrome causing myocardial stunning.
Symptoms and signs
Symptoms include profound weakness, cold and clammy skin, rapid and weak pulse, severe breathlessness, confusion or reduced consciousness, and very low urine output. Blood pressure is significantly reduced (systolic typically below 90 mmHg).
Treatment
Treatment is delivered in an intensive care unit and may include intravenous medications to increase blood pressure (vasopressors and inotropes), mechanical circulatory support devices (such as an intra-aortic balloon pump or Impella device), and treatment of the underlying cause (for example, emergency PCI to open a blocked coronary artery). ECMO may be used in the most severe cases. Despite intensive treatment, cardiogenic shock carries a significant mortality rate.
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