Cardiogenic Shock

Cardiogenic shock is a life-threatening condition, when there is a sudden deterioration of heart function, resulting in a weakened heart which is no longer able to pump sufficient blood around the body. If not promptly treated, patient with cardiogenic shock will quickly progress to failure of other vital organs, eventually resulting in death.

Common causes of cardiogenic shock include

• Acute myocardial infarction ('heart attack')
• Acute myocarditis (inflammation of the heart muscles)
• Deterioration of chronic heart failure
• Severe disturbance of the intrinsic heart rhythm
• Sudden disruption of heart valve function

• Shortness of breath
• Chest pain
• Unexplained loss of consciousness
• Change in mental status
• Abrupt decrease in urine output
• Cold peripheries

The condition is diagnosed by a multi-disciplinary Cardiogenic Shock Team comprising of cardiologists, intensive care physicians, cardiothoracic surgeons, and other allied health professionals who work together to integrate various clinical information, including:

• Patient symptoms
• Clinical examination findings
  • Signs of heart failure/ fluid retention
  • Features of cardiogenic shock, such as cold extremities
• Laboratory tests
  • Troponin levels: a protein released following heart muscle damage, to look for any evidence of acute myocardial infarction ('heart attack')
• Electrocardiogram ('ECG')
  • Electrical tracing of the heart, looking for evidence of acute myocardial infarction ('heart attack')
• Chest radiograph
  • X-ray of the chest to look for abnormal heart enlargement/ abnormal fluid collection in the lungs because of acute heart muscle weakening/ heart failure
• Echocardiogram
  • Ultrasound examination which allows doctors to assess heart function and find out the cause of cardiogenic shock
• Invasive tests
  • Coronary angiogram: look for presence of blood vessel blockages which can account for the sudden weakening of the heart
  • Right heart catheterisation: invasive procedure that introduces a pressure monitoring catheter into the right side of the heart. The right heart catheterisation findings will allow us to adjust the patient's medications, with the hope of altering the cardiogenic shock disease trajectory

Immediate recognition and prompt resuscitation are the keys to survival for patients with this dreaded condition.  The treatment options for these patients include

• Medications that increase the pumping strength of the heart (inotropes)
• Coronary angioplasty ('stenting procedure')
  • In patients with heart attack causing cardiogenic shock, interventional cardiologists will attempt to restore blood flow by opening the blocked blood vessels using catheter systems
• Mechanical circulatory support (mechanical pumps that temporarily replace the patient's heart function) in patients who remain critically ill despite initiation of medications to improve heart pumping function
  • Catheter-based left ventricular assist devices (Impella® pumps)
  • Veno-arterial extracorporeal membrane oxygenation (VA-ECMO)

At the National University Heart Centre, Singapore (NUHCS), a multi-disciplinary Cardiogenic Shock Team is available for the prompt diagnosis and treatment of patients with cardiogenic shock, to improve these patients' chances of survival.

NUHCS multi-disciplinary Cardiogenic Shock Team in the Intensive Care Unit (ICU) taking care of a patient with Cardiogenic Shock, managed using the Impella® catheter-based left ventricular assist device.