Cardiogenic Shock

Treatment

Since cardiogenic shock (CS) is a life-threatening condition, you’ll need immediate medical treatment for the best possible health outcome. Overall, the prognosis of individuals with CS is poor, as about 50%–75% of cases result in death if not treated immediately.¹ Treatment will focus on improving blood pressure, breathing, and heart function by restoring oxygen-rich blood flow to your heart and preventing significant organ damage. Most people with CS will be given extra oxygen, along with medications. More severe cases of CS may also require additional interventional cardiac procedures, cardiac support devices, and/or surgeries.

Medications

Treatment for CS may include the following medications:

Additional treatments

In addition to medications, you still may require additional treatments if your CS is more severe. These treatments may include interventional procedures, mechanical support devices, and/or surgeries.

Catheter-based interventional procedures

• Angioplasty and stenting – In this procedure, your doctor inserts a long, thin tube called a catheter into your heart via an artery in your upper thigh and guides it through the arteries to your heart and the area of blockage. With the catheter in place, the doctor threads a tiny wire carrying a deflated balloon on its tip through the catheter to the narrowed portion of the artery. As the tiny balloon is inflated, it compresses the blockage against the inside wall of the artery, which reopens the artery to restore blood flow. A metal mesh stent is typically inserted into the artery to keep it open over time.

Mechanical support and implantable devices

• Intra-aortic balloon pump (IABP) – In this procedure, your doctor inserts a balloon pump in the aorta, the heart's main artery. As the pump inflates and deflates, it helps your heart pump blood to the rest of your body, thus requiring less effort from your heart.
• Left Ventricular assist device (LVAD) – An LVAD is a mechanical device that helps to pump blood from your heart’s main pumping chamber (left ventricle) to your aorta (the main artery of the heart). An LVAD allows your heart muscle to rest and, in some cases, even recover. LVADs are used in patients waiting for a heart transplant and sometimes after open-heart surgeries to allow the heart muscle to rest. They also have been shown to increase survival rates in heart failure patients.
• Extracorporeal membrane oxygenation (ECMO) – In critical situations, ECMO involves using a heart-lung machine to help improve blood flow and supply oxygen-rich blood throughout your body. The ECMO machine bypasses your heart and lungs by pumping blood outside your body, removing carbon dioxide, and then sending oxygen-filled blood back to your body. This process performs the normal functions of your heart and lungs and gives your organs time to rest and recover.
• Pacemaker – A pacemaker is a small, battery-powered device that will help keep your heart beating regularly. The device, implanted under your skin near your heart, monitors your heart rate and sends electrical impulses to your heart.

Surgeries

• Surgical repair of a heart injury – CS can sometimes be caused by a heart injury like a damaged heart valve or a tear in a heart chamber. If your CS is caused by an injury, surgical repair might be your best option.
• Coronary artery bypass graft surgery (CABG) – CABG is a surgical treatment in which doctors graft a vein from a leg (or another part of your body) to your coronary artery to enable blood to “bypass” a blockage and continue to supply blood flow to your heart muscle. Your doctor might suggest this surgery to you after you’ve had a heart attack and your heart has had time to recover.
• Heart transplant – If all other treatment options have failed and you’ve reached end-stage heart failure, your last option may be having a heart transplant.

References

1. Cardiogenic shock: MedlinePlus Medical Encyclopedia