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[Conditions](https://durgical.com/en/conditions/) · [Cardiology](https://durgical.com/en/conditions/)

# Cardiogenic shock

Cardiogenic shock happens when the heart pumps so poorly that organs do not get enough blood. It is usually caused by a large heart attack.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Left ventricle](https://durgical.com/en/anatomy/left-ventricle/)
- [LAD (anterior descending artery)](https://durgical.com/en/anatomy/anterior-interventricular-artery/)
- [Left ventricle papillary muscles](https://durgical.com/en/anatomy/superior-papillary-muscle-of-left-ventricle/)
- [Interventricular septum](https://durgical.com/en/anatomy/interventricular-septum/)
- [Right ventricle](https://durgical.com/en/anatomy/right-ventricle/)
- [Right coronary artery](https://durgical.com/en/anatomy/right-coronary-artery/)
- [Circumflex artery](https://durgical.com/en/anatomy/circumflex-artery-of-heart/)

## In embryology

- [Hypoplastic left heart syndrome](https://durgical.com/en/embryology/hypoplastic-left-heart-syndrome/)

## In the clinical exam

- [Shock: the clinical signs and the types](https://durgical.com/en/clinical-exam/shock-the-clinical-signs-and-the-types/)

## Why it happens

- [Infarction: red vs white, and what decides the damage](https://durgical.com/en/general-pathology/infarction-red-vs-white-and-what-decides-the-damage/)
- [Shock: types, stages and the organs it damages](https://durgical.com/en/general-pathology/shock-types-stages-and-the-organs-it-damages/)
- [The myocardial infarct over time: what the pathologist sees from hours to months](https://durgical.com/en/general-pathology/the-myocardial-infarct-over-time-what-the-pathologist-sees-from-hours-to-months/)
- [Watershed areas and the organs most sensitive to ischemia](https://durgical.com/en/general-pathology/watershed-areas-and-the-organs-most-sensitive-to-ischemia/)
- [Shock physiology](https://durgical.com/en/physiology/shock-physiology/)
- [The Frank–Starling mechanism](https://durgical.com/en/physiology/the-frank-starling-mechanism/)

## Show 1 more

- [Coronary circulation and myocardial ischemia](https://durgical.com/en/physiology/coronary-circulation-and-myocardial-ischemia/)

## What it is

A state of low cardiac output with tissue hypoperfusion caused by a primary heart problem, typically systolic blood pressure below about 90 mmHg with signs of poor organ perfusion despite adequate filling.

## Who gets it

It complicates a minority of acute myocardial infarctions but is the leading cause of in-hospital death after infarction. In Colombia and Latin America, outcomes depend on timely access to primary angioplasty and intensive care, which is uneven outside large cities.

## Causes

- Acute myocardial infarction with extensive left ventricular damage (the most common cause)
- Mechanical complications of infarction: papillary muscle rupture with acute mitral regurgitation, ventricular septal rupture, free wall rupture
- Right ventricular infarction
- End-stage cardiomyopathy or decompensated heart failure, acute myocarditis
- Severe valve disease and sustained arrhythmias

## Risk factors

- Large anterior infarction (proximal LAD occlusion) or multivessel disease
- Older age, diabetes and previous infarction or heart failure
- Delayed reperfusion

## Pathophysiology

Loss of contractile myocardium lowers stroke volume and cardiac output. Low blood pressure reduces coronary perfusion, which causes more ischaemia and a downward spiral. Compensatory vasoconstriction and fluid retention raise filling pressures and cause pulmonary congestion, and the inflammatory response can add vasodilatation. The classic profile is «cold and wet»: high wedge pressure, low cardiac index and high systemic resistance.

## Classification

- Haemodynamic profile: cold and wet (most common), cold and dry
- Severity staging from at risk to refractory shock (SCAI stages A to E)
- Predominantly left, right or biventricular failure

## Symptoms and signs

- Hypotension with a weak, fast pulse
- Cold, clammy, mottled skin and delayed capillary refill
- Confusion or agitation
- Low urine output
- Dyspnoea and lung crackles from pulmonary oedema
- Chest pain when the cause is an infarction

## Red flags

- Rising lactate or falling urine output despite treatment
- A new loud systolic murmur after infarction (papillary muscle or septal rupture)
- Hypotension with clear lungs and raised jugular venous pressure (right ventricular infarction or tamponade)
- Sustained ventricular arrhythmias

## Diagnosis

**Clinical**
Hypotension with signs of hypoperfusion (cold [skin](https://durgical.com/en/anatomy/skin/), confusion, oliguria) and usually congestion; examination for new murmurs, jugular venous pressure and lung crackles.

**Tests**
12-lead ECG (ST elevation, right-sided leads), troponin, lactate, arterial blood gas, [kidney](https://durgical.com/en/anatomy/kidney/) and [liver](https://durgical.com/en/anatomy/liver/) function, natriuretic peptides; invasive haemodynamics (pulmonary artery catheter) in selected cases: low cardiac index and high wedge pressure.

**Imaging**
Urgent echocardiography to assess ventricular function and exclude mechanical complications and tamponade; coronary angiography to find the culprit lesion; [chest](https://durgical.com/en/anatomy/region/chest/) X-ray for pulmonary oedema.

## Differential diagnosis

- Hypovolaemic shock
- Septic (distributive) shock
- Obstructive shock: massive pulmonary embolism, cardiac tamponade, tension pneumothorax
- Anaphylaxis

## Goal of treatment

Restore perfusion quickly by treating the cause (above all, opening the infarct-related artery), supporting blood pressure and cardiac output, and preventing multi-organ failure.

## Treatment

**Acute**
Oxygen or ventilatory support as needed, arterial line, careful fluids only if there is no congestion (for example in right ventricular infarction).

**Procedure**
Emergency coronary revascularisation, usually percutaneous coronary intervention of the culprit artery; surgery for mechanical complications or anatomy unsuitable for stenting.

**Medical**
Vasopressors (norepinephrine is preferred) to keep perfusion pressure and inotropes (dobutamine, milrinone) to raise cardiac output; loop diuretics for congestion once pressure allows.

**Procedure**
Temporary mechanical circulatory support in selected patients: intra-aortic balloon pump, percutaneous ventricular assist devices or extracorporeal membrane oxygenation (ECMO), as a bridge to recovery, transplant or a durable device.

**Follow-up**
Intensive care monitoring: blood pressure, heart rhythm, hourly urine output, lactate trend, mental status and kidney function; nursing care focused on perfusion and safety.

## Complications

- Multi-organ failure: acute kidney injury, ischaemic liver injury, bowel ischaemia
- Ventricular arrhythmias and cardiac arrest
- Respiratory failure
- Bleeding and limb ischaemia from devices and arterial access
- Death

## Prognosis

Mortality remains high, around half of patients in many series. Early revascularisation of the culprit artery is the intervention that has most clearly improved survival.

## Prevention

- Fast recognition and reperfusion of myocardial infarction
- Optimal treatment of heart failure

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common cause of cardiogenic shock?

Acute myocardial infarction with extensive left ventricular damage.

## What is the classic haemodynamic profile of cardiogenic shock?

Low cardiac index, high pulmonary capillary wedge pressure and high systemic vascular resistance: «cold and wet».

## Which treatment most clearly lowers mortality in shock due to infarction?

Early revascularisation of the infarct-related artery, usually by percutaneous coronary intervention.

## Which vasopressor is generally preferred in cardiogenic shock?

Norepinephrine, often combined with an inotrope such as dobutamine.

## A patient with an inferior infarction is hypotensive with clear lungs and distended neck veins. What is suspected?

Right ventricular infarction; it is preload-dependent, so nitrates are avoided and cautious fluids are given.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/cardiogenic-shock/)

## Related conditions

- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)
- [Heart failure](https://durgical.com/en/conditions/heart-failure/)
- [Mitral regurgitation](https://durgical.com/en/conditions/mitral-regurgitation/)
- [Ventricular tachycardia](https://durgical.com/en/conditions/ventricular-tachycardia/)
- [Cardiac arrest (VF, pulseless VT, asystole, PEA)](https://durgical.com/en/conditions/cardiac-arrest/)
- [Cardiac tamponade](https://durgical.com/en/conditions/cardiac-tamponade/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)
- [Hypovolaemic shock](https://durgical.com/en/conditions/hypovolaemic-shock/)
- [Sepsis and septic shock](https://durgical.com/en/conditions/sepsis-and-septic-shock/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Cardiogenic shock: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000185.htm) (MedlinePlus, US National Library of Medicine, 2026).

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Source: https://durgical.com/en/conditions/cardiogenic-shock/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/cardiogenic-shock/