In cardiogenic shock the heart pumps so weakly that organs do not get enough blood, even though there is enough fluid in the body. The most common cause is a large heart attack, and death rates stay high unless the cause is treated fast, often by opening the blocked artery.
Key symptoms
- Shortness of breath, worse lying flat
- Chest pain if caused by a heart attack
- Confusion, agitation or drowsiness
- Cold, clammy skin
- Little or no urine
What you find on exam
- Systolic pressure below 90 mmHg or drugs needed to keep it up
- Fast, weak pulse
- Cold, mottled limbs with slow capillary refill
- Lung crackles and raised jugular venous pressure
- New murmur pointing to a mechanical complication
Tests
- 12-lead ECG to look for STEMI
- Echocardiogram: pump function and mechanical complications
- Lactate, troponin, kidney and liver function, electrolytes
- Arterial blood gas and chest X-ray
- Pulmonary artery catheter in selected patients
Treatment basics
- Urgent PCI if caused by a heart attack
- Norepinephrine for low blood pressure; dobutamine to support pumping
- Oxygen or ventilation support as needed
- Mechanical support such as an intra-aortic balloon pump or Impella in selected patients
- Small fluid boluses only if not overloaded; diuretics once pressure is stable
Red flags
- Rising lactate or falling urine output
- Worsening confusion
- Ventricular arrhythmias or cardiac arrest
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; NASEMSO National Model EMS Clinical Guidelines. Written by Making Synapses. Making Synapses is not affiliated with these organizations.