Cardiogenic Shock
Treatments

The goal of cardiogenic shock treatment is to quickly restore blood pressure and heart function. This often requires a series of immediate treatments that are given in an ambulance or the emergency room. Other treatments may include medications or temporary support devices to restore blood flow as well as longer-term therapies to address the underlying condition that caused the heart to stop pumping enough blood.

Emergency and short-term treatments

Emergency treatments may include delivering enriched oxygen via a tube or mask; breathing assistance, using a ventilator; and intravenous (IV) fluids and medications to support blood pressure or heart function.

Depending on the cause of cardiogenic shock, an array of drugs may be used as part of treatment. These include:

• Clot-busting drugs, such as tissue plasminogen activator (tPA) to dissolve coronary artery clots
• Anticlotting medicines – such as aspirin, clopidogrel or heparin – to prevent new clots
• Drugs to increase the heart's pumping ability, such as dobutamine, dopamine and norepinephrine
• Nitroglycerin to relax and widen blood vessels
• Drugs that decrease the heart's workload and pain, relieve anxiety or regulate heart rhythm

If medications don't stabilize your condition, your doctor may advise use of a support device that can temporarily take over the job of pumping your blood, restoring proper blood flow and giving your heart time to recover. These devices don't require invasive surgery. Options include:

• Intra-aortic balloon pump – A tiny balloon is placed in the aortic artery (the heart's main artery) via a thin, flexible tube called a catheter; the balloon inflates and deflates to move blood coming from your heart.
• Impella heart pump – Delivered via a catheter threaded through an artery, this small pump is implanted in the left side of the heart. It draws oxygenated blood from the heart and pushes it out to the body.
• Extracorporeal membrane oxygenation (ECMO) – An external device is used to pump and oxygenate your blood, allowing your heart and lungs to rest.

Longer-term treatments

Once doctors have determined the cause of a patient's cardiogenic shock, they may recommend various procedures or devices to address the underlying problem.

For a coronary artery blockage, treatments include:

• Coronary bypass surgery – a procedure to create a new route that allows blood to flow around a narrowed or blocked artery
• Percutaneous coronary interventions – minimally invasive procedures that use catheters to open a blocked artery and restore blood flow

For an abnormal heart rhythm, treatments include:

• Cardioversion – Medication or a brief electric shock resets the heart and restores a normal heartbeat.
• Pacemaker – This small electrical device regulates heartbeats; it's implanted under the skin and connected by wires to your heart.
• Catheter ablation – This minimally invasive procedure disrupts the electrical pathways causing the heart to beat too fast or irregularly.

If the cause of cardiogenic shock is a heart defect or advanced heart failure, more extensive treatment may be needed. Possibilities include surgery to repair or replace a faulty valve, mechanical circulatory support (devices that assist the heart's pumping action) or heart transplantation.