Your heart has an important job— keeping up with your body’s demand for blood. When your heart suddenly can’t pump enough blood to your body, you may be in danger of a deadly condition called cardiogenic shock. Cardiogenic shock is an emergency and it must be treated in a hospital immediately. Learn more about cardiogenic shock and what to do if you’re experiencing life-threatening symptoms.
Q: What is cardiogenic shock?
A: You can experience cardiogenic shock when your heart can’t pump enough blood to fuel your body. Your body’s cells, tissues and organs need oxygen from blood to work properly. Without blood, your organs can fail, and you can die. Cardiogenic shock is serious and requires emergency care immediately.
Q: Who is at risk for cardiogenic shock?
A: About 40,000-50,000 people in the U.S. experience cardiogenic shock every year. Certain groups of people are at a higher risk for cardiogenic shock, including those age 75 or older, women, Asian Americans, Pacific Islanders and people with heart problems, diabetes or who are obese. Women who experience cardiogenic shock due to a heart attack or heart failure are more likely to have severe cases of cardiogenic shock, may have atypical symptoms, and more complications than men, but more research is needed to fully understand why.
Q: What causes cardiogenic shock?
A: Cardiogenic shock is most often caused by a heart attack that restricts the amount of blood being pumped to the rest of your body. Cardiogenic shock can also be caused by other conditions that weaken heart muscle, including:
- Abnormal heart rhythm
- Blood around your heart
- Blood clot
- Chest injury
- Damage to the wall in the heart that separates the right and left ventricles
- Drug overdoses or poisoning
- Excess fluid around your heart
- Heart valve problems
- Heart failure
- Inflammation of your heart muscle
- Infection in your heart’s lining and valves
Q: How do I know if I’m in cardiogenic shock?
A: We typically see cardiogenic shock onset in one of two ways. Symptoms may appear seemingly without warning as in a heart attack with chest pains and sudden shortness of breath or more gradually with weakness, nausea, swelling of the legs and light-headedness occurring over time—as in heart failure.
In the early stages of cardiogenic shock you may need help from medicine or medical devices to move blood from your heart to your organs. If your condition worsens and your body does not respond to medications, your heart could stop beating, and you may need CPR, a ventilator or a defibrillator to help you breathe and get your heart beating again.
There is a staging system used to identify and stratify patients with cardiogenic shock. In Stage A (at risk), patients have risk factors for cardiogenic shock, such as a heart attack or heart failure. In Stage B (beginning), patients have either low blood pressure or evidence of poor blood flow to the skin (cold, clammy) or shortness of breath. In Stage C (classic shock), patients have both low blood pressure and evidence of poor blood flow to vital organs. In Stage D (deteriorating) patients have severely low blood pressure or evidence of organ damage. In Stage E (extreme), patients are likely to have cardiac arrest. You can find a detailed breakdown of the stages here.
If you notice you are breathing faster and feel panicked, confused, faint or your skin feels clammy, you should contact your doctor right away.
Other signs of cardiogenic shock include:
- Abnormal/rapid heartbeat
- Chest pain
- Cold hands/feet
- Confusion
- Fainting
- Lightheadedness
- Low blood pressure
- Pain in the upper body, upper abdomen, throat or jaw
- Pain in the left arm
- Pale skin
- Shortness of breath
- Sweating
- Swelling of the abdomen and legs
- Urinating less than normal
- Weak pulse
Q: How is cardiogenic shock diagnosed?
A: If you are experiencing signs of cardiogenic shock—call 911 or get to the Emergency Room. . Depending on your symptoms, they may want to test you for cardiogenic shock. There are tests that will help your doctor decide if you are in cardiogenic shock, including:
- Blood pressure check
- Cardiac catheterization
- Electrocardiogram
- Echocardiogram
- Chest X-ray
- Blood tests
Q: How is cardiogenic shock treated?
A: The treatment for cardiogenic shock depends on which of the five stages you’re in when you come to the hospital. Treatments will focus on moving your blood throughout your body and to your organs again. There are medications and devices that can help do the job of pushing blood to your body. You will likely be given oxygen and medications through a small tube called an intravenous or IV. You may also have a catheter placed into a blood vessel and into your heart to monitor your heart pressure. Other treatments will depend on what caused you to go into cardiogenic shock. Your doctor may recommend one or several of the following treatments, including:
- Angioplasty (opening a blocked artery in your heart)
- Help from a breathing machine (ECMO)
- Coronary artery bypass graft
- Heart valve repair or replacement
- Left ventricular assist device (LVAD)
- Removal of excess fluid
- Stent placement
- Temporary pump in aorta
Q: How can you prevent cardiogenic shock?
A: Cardiogenic shock is scary and can be life-threatening. Heart attacks are the most common cause of cardiogenic shock, so it’s important to seek emergency treatment if you think you are having a heart attack. If you have heart disease or other risk factors related to cardiogenic shock, your doctor will talk to you about ways to prevent a heart attack and lifestyle changes to keep your heart healthy. Your doctor may also recommend medications or devices that keep blood moving from your heart to the rest of your body, tissues and organs.
Q. Are there any new advances in the treatment of cardiogenic shock?
A: Cardiogenic shock poses a high risk of death, the good news is that there is extensive research being conducted into how best to treat cardiogenic shock. In 2024, the DanGer Trial was the first randomized controlled trial to demonstrate a reduction in mortality with a technology known as a micro-axial flow pump (mAFP) that is designed to help move blood from the heart to vital organs in the setting of cardiogenic shock due to a heart attack.
Tufts Medical Center and is at the forefront of research with cardiogenic shock. In 2022, the Medical Center’s Cardiogenic Shock Working Group (CSWG) reported the use of a staging system, known as the CSWG-SCAI Stages, to rapidly quantify the severity of cardiogenic shock and enable early decision making to improve survival. In 2024, the CSWG also developed novel tools to stratify risk in cardiogenic shock using machine learning and artificial intelligence methods. The group identified 3 specific types of cardiogenic shock that can be rapidly identified based on simple measures including blood pressure and simple blood tests. New technologies are also being developed to improve blood flow in cardiogenic shock and many of these devices are being studied in clinical trials at the Medical Center.
Learn how the Molecular Cardiology Research Institute (MCRI) at Tufts Medical Center is advancing our understanding and developing new strategies to treat cardiovascular disease.
