Cardiogenic Shock

Diagnosis

If you suspect you’re in cardiogenic shock (CS), you must act quickly and seek immediate medical attention, as CS often leads to death without prompt diagnosis and treatment. For doctors to confirm a diagnosis of CS, they will conduct a physical exam and a series of diagnostic tests.

Physical exam

Once you’re in a doctor’s care, your doctor will first obtain your medical history, including any symptoms you’re currently having and any medications you’re taking, and perform a physical exam, which may reveal the following signs of CS:

• Low blood pressure, usually with a systolic measurement (the top number in a blood pressure reading) of 90mmHg or less
• Blood pressure that drops more than 10 points when standing up after lying down (orthostatic hypotension)
• A weak pulse
• An irregular heart rhythm (arrhythmia) or heart murmur is heard in a stethoscope.
• Cold, clammy skin
• Hands and feet that are cold and/or swollen
• Low urination output levels

Diagnostic tests

In addition, your doctor will conduct several tests to confirm a CS diagnosis, which may include the following:

• Cardiac catheterization (angiogram) – This test involves inserting a long, thin tube (catheter) into your heart via an artery, usually in your wrist or groin, and injecting an X-ray dye into the arteries of your heart to see the flow of blood to your heart muscle and how well your heart is pumping. It can help detect blocked or narrowed arteries.
• Electrocardiogram (ECG/EKG) – This test records the electrical activity in your heart. It can detect abnormalities in your heart's rhythm and certain patterns that suggest portions of your heart may be injured or not get enough blood flow.
• Echocardiogram (echo, Doppler, heart ultrasound) – This noninvasive test uses sound waves to take pictures of your heart muscles, valves, and blood vessels in motion. It is crucial to assess whether all areas of your heart are working properly.
• Chest X-ray – This test produces an image of the inside of your chest showing the bones, heart, and blood vessels. It can be used to check for fluid in your lungs.
• Blood tests – These tests are used to check a variety of measurements, including oxygen and carbon dioxide levels (arterial blood gas tests), electrolyte levels, and cardiac enzyme levels (cardiac enzyme tests), among others, as well as checking for any non-heart organ damage and infections.

SCAI CS classification system

Once you’ve been diagnosed with CS, your doctor will also classify the severity of your CS based on the following classification system developed by SCAI.