The goal of cardiogenic shock treatment is to quickly restore blood pressure and heart function. This often requires a series of emergency treatments that are given in an ambulance or the Emergency Department. Other treatments may include medications or temporary support devices to restore blood flow.
Emergency Medical Treatment
These treatments may include enriched oxygen in a tube or mask; breathing assistance (ventilator); intravenous (IV) fluids and medications to boost blood pressure or heart function.
There is an array of medications that may be given to treat cardiogenic shock. These vary depending upon the cause of the shock and may include:
- Thrombolytic drugs to dissolve coronary artery clots ("clot-busting" drugs such as tPA)
- Anticlotting agents to prevent new clots (e.g., aspirin, clopidogrel, heparin)
- Drugs to increase the heart's pumping ability (e.g., dobutamine, dopamine, epinephrine)
- Other possible therapies include: oxygen to protect heart tissue; nitroglycerin to widen coronary vessels; drugs to decrease the heart's workload and pain, relieve anxiety or regulate heart rhythm
Temporary Support Devices
If medications are not enough to stabilize cardiogenic shock, your doctor may use one of the following temporary support devices to help restore proper blood flow:
- Intra-aortic balloon pump is placed in the aortic artery (the main artery of your heart) and provides an extra push to help move blood coming out of your heart.
- Other short term devices that are used to treat cardiogenic shock include: Impella, Tandem heart and extra corporeal membrane oxygenation (ECMO).
Procedures, Devices & Surgery
Once the cause of cardiogenic shock has been determined, your doctor may perform one of the following procedures to treat the problem:
- Bypass surgery is a common approach that surgeons use to create new routes through which blood can flow around blocked or narrowed arteries. These “bypasses” are created using healthy vessels taken from the chest (mammary), arms (radial) or legs.
- Balloon angioplasty is used to open blocked coronary vessels. During this minimally invasive procedure, a catheter (thin, flexible tube) is guided into the blocked artery and a tiny balloon is inflated to clear the way so that blood flow is restored. In some cases, a stent (small mesh tube) is inserted to keep the artery open.
One of the following procedures may be used to restore normal heart rhythm:
- Cardioversion is like a quick “reset” of the heart and is very effective for getting the heart back to its normal rhythm. Unfortunately is does not prevent the possibility of future arrhythmias. During this procedure a quick electrical shock is delivered to the heart using two large sticky pads that are placed on the chest and back. The shock also causes the muscles of the chest to suddenly contract, so it is done under anesthesia to avoid any pain or discomfort.
- Pacemaker is a small electrical device that is implanted under the skin, usually just below the collar bone in the chest, and is attached to one, two, or three small electrical wires that are threaded into a vein and then inside the heart. An electrical pacemaker is usually used to treat an abnormally slow heartbeat that causes symptoms (such as lightheadedness, fatigue, inability to exercise, shortness of breath, or fainting), or a very slow heartbeat that could be dangerous. Sometimes a special 3-wire pacemaker system is used to re-coordinate a heart that is beating in an uncoordinated way. A new type of extra small pacemaker is being studied, which does not have any wires but instead is a small metal capsule that is implanted inside the heart itself.
- Catheter Ablation is a minimally invasive procedure where several thin wires are threaded into the veins and/or arteries in the groin, and guided inside the heart to perform very detailed electrical testing of the heart. When abnormal electrical spots or short-circuits are identified, very precise heating or freezing techniques can be used to permanently eliminate the problem spots to cure or manage the fast or irregular heartbeat. Catheter ablation can be used to control symptoms, reduce the need for medications and provide a better quality of life for a wide range of electrical problems (arrhythmias). Many different high-tech tools are used during an ablation to give the doctor extremely detailed pictures and images to pinpoint the problem(s) and direct the very precise work that is done inside the beating heart.
In some cases, the underlying problem may result from a heart defect or failure. In these cases, valve repair/replacement surgery, mechanical circulatory support, or heart transplantation may be required.