Cardiogenic Shock (HB)

Cardiogenic shock is due to inadequate pumping of the heart. The most common cause of this is a heart attack. Your patient will complain of chest pain or pressure (“an elephant is sitting on my chest”), and you may also see signs of volume shock. The difference is that you may NOT see an accompanying increase in heart rate since the pump itself is failing. We will discuss treatment for chest pain in the section for Medical Emergencies.

The other cause of cardiogenic shock is trauma. In this case, the pump has been mechanically damaged from a direct impact or penetration. Damage to the heart tissue itself causes a problem since the damaged area cannot contribute to the contraction of the heart–thus weakening the overall effort.

The heart is encased in tissue called the “pericardial sack.” Blood can fill in the area between the heart and pericardial sack, which prevents the heart from completely filling as it is fighting against external fluid pressure. If the heart cannot fully load, it cannot produce the needed pressure.

Suppose you suspect cardiogenic shock due to trauma (impact to the chest from a fall or hitting the steering column of a car). In that case, the patient must go to a specialist–a cardiothoracic surgeon. A regular heart attack can go to any hospital for treatment–they are all capable of dealing with that issue. But not all hospitals staff a cardiothoracic surgeon, so sending a patient to a hospital without that resource can cause an unnecessary delay in treatment. Although it is not our decision to make as to what hospital they are taken to, we can affect the decision by doing good patient assessments and communicating this to EMS providers effectively.